Provider Service Representative

Position Purpose: 

Responsible for resolving provider inquiries via telephone and email correspondence in a timely and appropriate manner. Provider inquiries including claims, eligibility, covered benefits, authorization status issues

• Document all activities for reporting and resolution through the customer relationship management application (CRM)

• Answer inquiries from providers regarding claim, eligibility, covered benefits, authorization status issues

• Provide first call resolution through issue documentation and resolution with appropriate internal resource, follow-up and ensure closure with the contact who initiated the inquiry

• Respond appropriately to provider issues and concerns, and provide trending feedback to improve the customer experience

• Process customer correspondence and provide the appropriate level of timely follow up

• Manage service related follow up items and outstanding tasks in accordance with established turnaround times

• Provide assistance to provider regarding website registration, navigation and customer related inquires-Educate provider on health plan initiatives during interactions with providers via telephone

• Maintain performance and quality standards based on established call experience guidelines

• Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations’ team for claim adjustment

• Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction