• Provider Services Representative

    Job Locations US-RI-Smithfield
    Req No.
    2018-9773
    Department
    Member Services
    Type
    Regular Full-Time
  • Overview

    Under direction of the Supervisor, this role is responsible for providing accurate and thorough information on the plan’s benefits, claims, eligibility and policies to our providers and internal customers. In addition he/she is responsible for the resolution of customer inquiries, the facilitation of problem resolution and meeting or exceeding the customer’s expectation by addressing all of their issues or concerns.  He/she is expected to take personal and complete responsibility for every interaction with a customer as a means to build a business relationship, influence customer retention and satisfy corporate customer service goals and objectives.

    Responsibilities

    • Responsible for answering telephone inquiries via the call center and meeting and maintaining all required metrics, including call quality standards.
    • Leverage thorough knowledge of company policies, procedures, benefits, claims, and eligibility to respond accurately to provider inquiries
    • Very often the first “voice of the company” for providers, requiring a professional tone and exceptional level of plan, benefits, and claims knowledge
    • Establishes and maintains good working relationships with internal and external customers and interacts with other company staff, specifically in Claims, Medical Management, and Provider Network Management to resolve provider inquiries and problems
    • Demonstrates basic understanding of company billing guidelines and can effectively interpret and correct misunderstandings related to claims
    • Provides accurate documentation regarding inquiries in the Customer Service Call Tracking Applications
    • Investigates and refers claims to ensure problem resolution and minimize repeat calls
    • Adheres to assigned schedule to ensure proper phone coverage and optimal service levels to providers
    • Cultivates strong business relationships with provider community ensuring that network providers receive appropriate and timely responses
    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

    Qualifications

    Required: 

    • High School Degree or equivalent
    • 6 months - Customer Service/Call Center experience
    • Typing - strong skillset
    • Computer skills - intermediate
    • Telephone skills - excellent skillset
    • Communication skills (verbal/written) - advanced
    • Organizational skills - strong skillset
    • Attention to detail
    • Ability to handle highly confidential information
    • Persistence in locating and securing needed information
    • Interpersonal skills - strong
    • Work cross-organizationally and with external entities to achieve the goals of the department and organization
    • Medical terminology - working knowledge
    • Solutions-oriented, positive attitude
    • Handle multiple priorities within specific deadlines

    Preferred: 

    • Associate’s Degree or equivalent work experience
    • 1 – 2 years - Customer Service/Call Center experience
    • 1 – 2 years - Provider Service/Claims Call Center experience

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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