Job Location: Smithfield, RI - Smithfield, RI

Remote Type: Fully Remote

Position Type: Full Time

Education Level: High School or GED

Travel Percentage: None

Job Shift: Daytime

Description

Under direction of the Supervisor, this role is responsible for providing accurate and thorough information on the plans 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 customers 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.

Duties and 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
Other duties as assigned
Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods 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
One (1) year - 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:

1+ years - Customer Service/Call Center experience
1 2 years - Provider Service/Claims Call Center experience

Flexible Work Arrangement:

Candidates must be able and flexible to start work on any given day between 8am and 10am Monday through Friday and to work an 8 hour shift, which includes ½ hour uninterrupted unpaid meal break and 10 minute paid break for every 4 hours worked.

Telecommuting Arrangement:

This position works 100% remote and is assigned to a Permanent Remote Team. Occasional in-person days may be required. The training is in-person and will last about 4 weeks.

Training Dates (Monday-Thursday in-person, Friday remote)

Start Date 3/3/25

Neighborhood Health Plan of Rhode Island jobs

Provider Services Representative I