Medical Insurance Call Center Representative

Overview

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Medical Insurance Call Center Representative | Member and Provider Services Representative

Clearwater, FL

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• VERY competitive pay/compensation package

• Monthly metric bases bonuses

• NO selling, NO weekends

• Monday - Friday, Day Shift

• Paid Training, Health, Dental, Vision, and Life Insurance as well as Paid Time Off and Paid Holidays

This is a fun, challenging, and motivating work environment with a career path and opportunities for growth

Benefits: Join us and enjoy a robust benefits package designed to support your well-being

(Some plans vary by state.)

Full Time employees can enjoy:

• Health Coverage: Two flexible medical plans.

• Dental & Vision: Comprehensive coverage by Sun Life. Vision is company paid.

• Health Savings Account (HSA): Pre-tax contributions.

• Flexible Spending Accounts (FSA): Medical and Dependent Care options.

• Life & Disability Insurance: Company-paid, with optional additional coverage.

• Generous Paid Time Off (PTO), plus additional paid holidays.

• Employee Assistance Program (EAP): Wellness support

• 401k Retirement Plan: Participate and receive a company match after meeting eligibility requirements.

• Frequent and ongoing employee appreciation and celebration throughout the company

Summary:

Premier Administrative Solutions (PAS) is a Third-Party Administrator (TPA) that provides a wide range of administrative services to insurance companies, sharing organizations, insurance marketing organizations, and employers. One such service is Member and Provider Services, where inbound and outbound calls and correspondence from members or covered individuals and their providers are managed.

This service is provided subject to service level agreements which mandate a high level of service, including telephone service, accuracy, call resolution and satisfaction. The Member and Provider Service Representative (MPSR) is critical to PAS’ success, effectively and efficiently handling calls and correspondence.

To best serve its clients and their members, PAS’ Member and Provider Service Department is organized into Teams, each serving a specific client and/or product they offer. Each Team is managed by a Supervisor, responsible for delivering service excellence and provided the tools to do so. The number of MPSRs assigned to a team will vary based on the size of the client and the volume of calls and correspondence related to the client.

Responsibilities

Essential Duties and Responsibilities:

• Participating as a valued MPS Team member, including active participation in Team meetings where questions, issues are strategies for improving the Team’s service results are discussed.

• Promoting a culture within the Team of exceptional service to members and their providers, as well as transparency in discussion of issues and concerns with the Team Supervisor and Department management.

• Meeting Department standards for productivity, including number of calls handled per day and week, percentage of time spent in the queue or on calls and Team phone service levels (i.e., percentage of call answered by a live operator in 45 seconds, average speed to answer, longest hold time and abandon rate).

• Maintaining a pleasant and helpful demeanor on the telephone with members and providers, ensuring that their questions are answered, and they indicate that their needs have been met.

• Ensuring that caller issues and interests are accurately identified, and accurate, understandable responses are provided. A minimum of 3 calls per week for MPS Representative will be audited by the Enterprise Risk Management (ERM) with accuracy a critical measure.

• Adhering to Company standards to documentation of all calls. This includes the caller, reason for the call and sufficient information for other Team members to efficiently determine the information provided.

• Adhering to Team standards for escalation via transfer of calls to a more senior Representative or Supervisor.

• For any calls or correspondence where additional research is necessary, clearly explaining to the caller the steps that will be taken and expected timeframes, then clearly documenting the issue to the Supervisor or another Department. In each such “open call”, maintaining responsibility for communicating status and resolution to the original caller unless the Team Supervisor determines otherwise.

• Ensuring that Company policies and procedures related to HIPAA Privacy and Data and System Security are maintained at all times.

Essential Duties and Responsibilities Continued:

• When assigned the responsibility by the Team Supervisor, responsibility for ensuring that any messages left for the Team or scheduled outbound calls occur within 1 working day of the message being left or the request for an outbound call.

• When assigned the responsibility by the Team Supervisor, responsibility for ensuring that any correspondence received by the Team, including mail and electronic mail is answered within 1 working day. Any e-mail issue noted as urgent should be responded to within 4 hours.

• Adhering to Company policies and procedures on attendance, including requests for planned time off, reporting of sickness, start time and break times.

• As a Team member, continually support the Team’s efforts to provide exceptional service by identifying ideas for improvement in documentation and/or approach. These ideas should be shared with the Team Supervisor.

Primary Performance Expectations:

Performance review for each MPS Representative is ongoing, with formalized reviews quarterly. The results of the quarterly reviews will determine increases in responsibility, compensation, and incentive compensation. Performance expectations or goals are as follows:

Team Telephone Service Levels

• Service Level: Minimum of 80% of calls reach a live Member and Provider Service Representative within 30 seconds.

• Average Speed to Answer: The average speed to be answered for all calls with be less than 30 seconds.

• Abandon Rate: For all calls reaching the Team’s phone queues, less than 5% will result in the caller hanging up prior to reaching a Representative.

Individual Production Level

• Handle a minimum of 275 MPS transactions per week. A transaction is defined as an inbound call, outbound call where the intended target for the call is reached, or a written response to inbound mail or e-mail.

Quality Level

• A minimum of 10 calls per week will be audited and the overall Team score must average a minimum of 95% of higher.

Qualifications

Experience and/or Education:

• High school graduate or equivalent.

• Knowledge of medical terminology, billing, claims and the health insurance industry is strongly preferred but not required.

• A minimum of at least one year working in an inbound Customer Service Center focused on health insurance or provider billing.

• Strong organizational, interpersonal and motivational skills.

• Excellent listening, written and verbal communication skills.

• Ability to perform multiple tasks at one time, including listening, navigation of information via the computer and documentation of discussions.

Environmental Factors/Physical Demands:

Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping, and lifting up to thirty (30) pounds.

HIPAA and Data Privacy Obligations:

This role has direct access to Protected Health Information (PHI). The following rules are non-negotiable:

• Absolute confidentiality: Employees must not disclose PHI to unauthorized individuals under any circumstances.

• Secure environment: A private, locked workspace must be maintained to prevent exposure of PHI to family members, visitors, or others.

• Company-approved technology only: All work must be performed on secure, company-issued devices using encrypted connections (VPN required).

Other Responsibilities:

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change at any time with or without notice.

• Adheres to the policies and procedures of Company

• Maintains strict confidentiality of client, company and personnel information

• Demonstrates a strong commitment to the mission and values of the organization

• Adheres to company attendance standards

• Performs other duties as assigned

At-Will Employment (Florida):

Please note that employment in Florida is at-will, and either you or Premier Administrative Solutions (“PAS”) may terminate the employment relationship at any time, with or without cause or notice. Nothing in this letter creates a contract for continued employment.

Drug Free Work Place

Premier Family of Companies and its affiliates is committed to providing a safe, healthy, and productive work environment for all employees. To achieve this, PAS maintains a smoke-free and drug-free workplace. Candidates who receive a conditional offer must complete a pre-employment drug screen. Random and post-incident testing may also be required.

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Medical Insurance Call Center Representative | Member and Provider Services Representative

Clearwater, FL

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PA123

Job Locations US-FL-Clearwater

ID 2025-2734

# of Openings 4

Category Customer Service/Support