Responds to provider inquiries regarding eligibility and benefit verification in a professional, timely, accurate manner while consistently meeting all guidelines.
Department: Provider Relations
Reports to: Mgr, Provider Operations
Additional Responsibilities:Candidate Education:
- Responds to provider inquires via telephone while meeting all corporate guidelines and performance standards.
- Provides eligibility and benefit information to providers.
- Identifies & researches all member/provider eligibility issues initiated by the provider.
- Forwards enrollment discrepancies to the Enrollment Department for follow up and resolution.
- Handles eligibility fax inquiries per department standards.
- Records and forwards provider complaints/grievances to applicable departments.
- Educates providers telephonically on how to administer online eligibility verifications via the website.
- Demonstrates appropriate customer care skills such as active listening, courtesy, politeness, helpfulness and other skills as identified.
- Performs other duties as assigned.
- Required A High School or GED
- Preferred 6 months of experience in a Call Center environment
- Preferred Other Previous experience in the Health Care Industry
Licenses and Certifications:
- Beginner Other Written communication skills
- Intermediate Other Verbal communication skills
- Beginner Other Organization skills
- Intermediate Other Time management and prioritization skills
- Beginner Ability to effectively present information and respond to questions from families, members, and providers
- Preferred Other Customer Service, quality or training certification
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word