Provider Service Rep- Commercial Tufts Health Plan 207 reviews - Watertown, MA 02472 Under direction of the Provider Services Call Center Supervisor, the Provider Services Specialist is responsible for providing accurate and thorough information on THP benefits, claims, eligibility, and policies to providers, prospective providers, and internal customers. In addition to providing accurate technical information, the Provider Services Specialist 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. The Provider Services Specialist is expected to take personal and complete responsibility for every interaction with a customer by providing "world class" service as a means to build a business partnership, influence member retention, and satisfy corporate customer service goals and objectives. Functions as the front-line contact for providers by responding to a high volume of incoming calls from providers, prospective providers, and internal THP staff. Part Time & Full Time Schedules available ranging from 25-40 hours a week with full benefits! KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance) % of TIME (Optional) Technical and Functional Knowledge Responds accurately to provider inquiries regarding THP policies, procedures, benefits, claims, and eligibility. Possesses thorough knowledge of THP policies, procedures, benefits, eligibility, and claims. Interacts with other THP staff, particularly in the areas of Claims, Fee and Reimbursement, Allied Health, and Network Contracting to resolve customer inquires and problems. Efficiently accesses all resource materials needed to effectively and accurately interpret, respond, and resolve customer inquires and concerns. Demonstrates basic understanding of THP billing guidelines and can effectively interpret and correct misunderstandings related to claims. Accurately logs all calls in IMAX with appropriate inquiry and reason codes and documents comprehensive memos regarding each customer interaction. Employs proper uses of telephone stats (Log in, Log out, Work mode, etc.) as dictated by the Call Center Best Practice Guidelines. Investigates and adjusts claims to ensure problem resolution and minimize repeat calls. Adheres to assigned schedules to ensure proper phone coverage, which contributes to optimal service levels for the call center. Adhoc assignments as necessary 25% Customer Service Copes with the stress of high call volume or emotionally charged encounters by approaching each call with level-headedness, compassion, and empathy. Employs a four part greeting and closure along with a personalized voicemail message as defined by the Call Center Best Practice Guidelines and department polices and procedures. Informs callers of the reason for being placed on hold or being transferred and asks permission of the caller to do so. Demonstrates patience and respect for callers, both internal and external at all times. Recaps the caller's issue and proposed resolution. Displays a commitment to the department's Mission Statement by consistently providing "world class service" on behalf of the customer, both internal and external. 25% Communication Communicate to supervisor regarding any potential needs or concerns. Expresses spoken and written thoughts with customers clearly and logically with correct use of grammar and effective composition and attention to detail. Treats customers' issues with complete confidentiality in both verbal and written form, including co-workers and other THP staff. Reaches agreement and re-states planned steps with customer on specific action to be taken to resolve issue. Effectively defuses anger during difficult interactions and delivers responses in a rational and understandable manner. Displays positive interpersonal skills and demonstrates a spirit of cooperation with other THP staff when resolving an issue. Communicate and interact with supervisor on a daily basis. 25% Decision Making/Problem Solving Considers and proposes creative alternatives to difficult problems. Understands how to utilize internal resources to resolve an issue or make a decision regarding a THP policy or guideline. Independently resolves issue with attention to detail, and in cooperation with other THP departments. 25% EDUCATION: (Minimum educations & certifications required) Associates degree or equivalent relevant work experience is preferred. Excellent verbal and written communication skills are required. EXPERIENCE: (Years of experience) Minimum of 6 months experience in a service environment required. Call center experience preferred. SKILL REQUIREMENTS: (Include interpersonal skills) Proficiency with MS Windows, keyboarding skills, strong verbal, written communication skills, strong organizational skills as well as the ability to research and respond to a high volume of telephone inquiries in a consistent and professional manner. Basic math, grammar, and spelling are required. Knowledge of medical terminology is preferred. Ability to work under pressure and with attention to changing priorities. Must be able to work cooperatively as part of a team with excellent interpersonal skills and an ability to provide outstanding customer service in order to promote a positive company image. Must be able to effectively communicate with all internal departments and external business partners in verbal and in written formats. Acts as a professional at all times, adhering to the THP Code of Conduct. Must have strong computer and telephone multitasking skills: effectively search for and key information on the computer while maintaining the pace of a customer call: navigate through windows and screens quickly, input information correctly and keep pace with the call. Key responses to prior questions while asking new questions. While maintaining telephone conversation with customers, simultaneously access resources to answer questions or solve problems. WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel, overtime) Fast paced office environment handling multiple demands and exercising appropriate judgment when necessary. Open cubical environment with a Personal Computer, telephone, and answering queue calls while documenting each interaction. Occasional overtime may be requested. CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy and department guidelines/policies and all applicable laws and regulations at all times. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled 1 hour ago - save job - original job Apply On Company Site Other jobs you may like Employee Service Center Representative I Fresenius Medical Care Waltham, MA 4 hours ago Customer Service Representative BSS Watertown, MA 1 day ago Easily apply Customer Success Associate CarGurus Cambridge, MA 6 hours ago Easily apply Customer Success Advocate Mimecast Lexington, MA 21 hours ago Bargain Outlet Customer Service Representativ... E.C. 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