Provider Services Representative

SFM Mutual Insurance Companies•Bloomington, MN

6d•Hybrid

About The Position

At SFM, our Provider Service Representatives work in a team-driven environment in our Insurance Operations Department. This department is the “hub of SFM”. It is multi-functional, fast-paced, and production-oriented. This role has a variety of tasks which include requesting records, monitoring those requests and working with a multitude of provider/vendor relationships analyzing documentation for the retention and or retrieval of documents in accordance with established best practices and procedures. You will play a vital role in the management of workers’ compensation claims and be part of SFM’s goal of delivering unrivaled customer service seeking positive outcomes for employers and injured workers in connection with a workers’ compensation claim. Our employees are encouraged to “do the right” thing and lead from within. If you thrive in an environment that gives you lots of variety, than this position may fit your professional goals.

Requirements

Associates degree, or equivalent work experience relevant to the role.
Four or more years’ experience working in an insurance operations environment processing medical claims/bills, workers’ compensation claims, commercial or property casualty insurance claims or related field.
Demonstrated experience providing customer driven solutions, support, and/or service.
Excellent customer service abilities and able to manage difficult situations effectively.
Strong working knowledge handling workers’ compensation, property/casualty, health insurance claims, or processing insurance policies is highly desirable.
Exceptional communication/interpersonal skills and ability to interact within a diverse team environment and collaborate with other business partners.
Excellent oral, written communication and presentation skills.
Excellent MS Office software applications (Excel, Word, ) and familiarity with working within a paperless environment.
Strong attention to detail with the ability to verify and cross check
Strong organizational, time management and troubleshooting skills.
Must be able to work on business premises

Responsibilities

Request and obtain a variety of documents/records in connection with a workers’ compensation claim or legal investigation under the direction of a claims or legal representative and does so in a timely manner ensuring that all time lines are met.
Follow up on documents that are not received and communicate with internal customers providing updates on the status of requests and dig into files to find missing information.
Forward the records received to the correct file, documents receipt of the needed records and verifies the quality of the received information while ensuring the records are organized and presentable for the customer, and provide regular updates concerning the status of request.
Review, authorize, submit, and reconcile invoices for requested records using State specific regulations, internal policies and guidelines as well analyzing, troubleshooting and responding to inquiries related to duplicate payments and pursues active reconciliation to include recovery of funds as needed.
Provide guidance concerning SFM’s billing practices and acts as a resource for providers concerning bills submitted for payment while looking for efficiencies improving e-billing opportunities and troubleshooting areas of discrepancy concerning bills submitted for payment and created documentation as needed.
Handle complex matters and deals with escalated situations and issues with limited supervision and may contribute to miscellaneous team tasks when needed and acts as a liaison with medical providers and other vendors, resolving billing inquiries and gathering additional information as necessary.
Maintain the internal medical provider and legal database tables, making accurate updates when needed and handles W-9 tax forms when appropriate for the maintenance of the medical provider table as well as handling monthly and quarterly reports pertaining to the vendor and provider table and its information integrity.
Follow State and Federal regulations, as well as comply with HIPPA requirements, internal policies and guidelines while requesting confidential information and records.
Manage confidential information with discretion and good judgement in accordance with team and Company guidelines.
Provide a high level of customer service for all business partners and customers while adhering to the Company’s service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality service to internal and external customers and all business partners.