Medical Insurance Call Center Representative [Full Time]

CHS•Clearwater, FL

26d•Onsite

About The Position

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.

Requirements

High school graduate or equivalent.
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.

Nice To Haves

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

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.
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.

Benefits

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.

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