Provider Service Specialist

4 weeks ago

Houston, United States Hirewell Full time

Our client is a legal access employee benefits company that makes the needs of members a priority and strives to offer them the best product and service in a personal, but professional, manner.


Join the Team:


This is a customer focused work environment; providing service, respect, and dignity to our members and team. The deeply instilled culture is personified by Team Members who ensure that they have helped each and every member to the best of their abilities, and to become a company that is easy to work with. If you want to be a part of this cohesive team with opportunities to build a successful career, this is the right place for you


Job Purpose:


We are looking for a detail oriented, efficient individual who can derive a sense of pride and fulfilment in work well done. This role will require the skilled mastery of warm calling with the ability to build genuine relationships and yield great matching results. Responsible for performing a wide range of administrative duties including referral processing by meaningfully matching members with appropriate legal representation. The Specialist works in a call center environment that requires verbal and written communication with referral sources and benefit information to providers and other tasks assigned. The Specialist works in a team environment and is expected to consistently maintain established department quotas as defined by management.


ESSENTIAL DUTIES:

  • Analyze Case Profile
  • Warm calling providers when appropriate provider options are limited or do not exist. Negotiating network discounts.
  • Managing Accountability sheet daily.
  • Communicate with Member Specialist or Manager for any additional information to ensure an appropriate referral.
  • Search for a Provider referral options using the provider database and established department resources/ proper procedures.
  • Confirm Provider is properly credentialed and approved.
  • Place phone calls to Providers for case matching; All actions and information concerning matching must be documented within the case.
  • A minimum of three (3) match attempts must be made daily per case.
  • Confirmation of all matching points must be satisfied: distance, timeliness of referral, benefits, costs, area of practice, and member preferences.
  • Send proper benefit confirmations and payment information (claim forms, payment instructions) to Provider referral option.
  • Send all proper documents to Provider (i.e. Questionnaire and Contract)
  • Properly update the Attorney Database.
  • Communicate effectively and in a timely fashion with members, providers, teammates, and management.
  • Complete a Daily Status Updates when referrals are not ready the same day or the next day, so that the information can be communicated to the member.
  • Respond to all phone messages and emails within one (1) business day.
  • Report daily activity, using the standard (EOD) End of Day Report format.
  • Assist with status updates, providing referrals, and making follow up calls as needed when call volume or staffing issues require assistance.


You will do it using your:

  • Excellent verbal and written communication skills.
  • Ability to take ownership of project.
  • Ability to meet aggressive deadlines while maintaining a positive attitude.
  • Must be confident calling attorneys for negotiating service sales or recruitment background preferred
  • Ability to work under pressure and follow through on tasks.
  • Strong organizational skills, Ardent, with an applicable sense of urgency.
  • High attention to detail and proven ability to manage multiple, competing priorities simultaneously with minimum supervision.
  • Ability to build relationships with leadership team/department heads
  • Ability to maintain in-depth working knowledge of internal systems and processes.


QUALIFICATION & POSITION REQUIREMENTS:

  • High School Diploma, College Degree preferred.
  • Minimum three (3) years customer service, insurance, or account management experience
  • Must demonstrate strong customer service skills, displaying sound judgement and decision-making
  • Must manage customer expectations by resolving issues in a timely manner.
  • Must plan work appropriately and balance multiple priorities.
  • Excellent communication skills, both written and verbal.
  • Must maintain the highest level of professionalism.
  • Microsoft Office proficiency.
  • Must have reliable transportation


Our Offering:

  • Culture built on Trust, Respect, and Integrity
  • Environment that supports the personal drive for excellence
  • Access to robust health insurance and legal benefit plans
  • Training and Development opportunities
  • Paid vacation
  • Free Fitness Center on property
  • 401 (k) Retirement plan


The Provider Service Department's operating hours are 7:00 am 7:30 pm Central Time.

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