Provider Relation Representative, HYBRID-DE

Summary

Minimum 1 years’ experience in a call center environment required. Experience in health/human services and knowledge of Medicaid preferred. Provide excellent customer service primarily by telephone to Medicaid Providers and/or Members. Assist customers with coverage/claims related questions.  Accurately interpret benefits and policy provisions for beneficiaries for the providers. Conduct appropriate research and follow-up for prompt resolution of disputed claims. 

Your role in our mission

Work efficiently in a high-volume call center while maintaining a professional, polite manner.   Assist callers with coverage related questions; accurately interpret policy Analyze customer’s inquiries and determine steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and organized. Document calls in a clear and consistent manner in computer system. Conduct appropriate research and follow-up for prompt resolution of disputed claims. Relay information to appropriate departments and personnel using established communication channels and procedures.  Must be able to type and talk at the same time and navigate through multiple screens Ability to maintain confidentiality and adhere to HIPAA requirements

• Participates productively as a member of a team.
• Completes tasks beyond general support level.
• Accepts instruction and direction from leadership. Ability to manage tasks and assignments without detailed direction.
• Identifies, prioritizes and resolves some issues independently, and escalates more complex questions or issues appropriately.  
• Complies with contract requirements, business unit rules and related and legal regulations         
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What we're looking for

• Prior office or clerical experience.
• Ability to follow written policies and procedures.
• Ability to access and retrieve information using a PC and basic understanding of Microsoft Office products.
• Ability to follow procedural guidelines.'
• Ability to work on assignments with limited instructions from leadership.
• Good written and verbal communication skills, including professional telephone skills.    

What you should expect in this role

• High School Diploma or equivalent; may hold 2-year post-high school Degree; may hold Bachelor’s degree.
• Typically, 1-2 years of working experience in related fields.
• Hybrid

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