Provider Services Associate, Care Center Representative

Status: Full Time, Non-Exempt

This role has broad range of on and off call responsibilities. On call responsibilities includes responding to customer inquiries in areas of enrollment, billing, claims, benefit interpretation, and referrals/authorizations for medical care. The majority of contacts are via telephone, with some in-office contact and written correspondence/e-mail and chat. May handle a variety of insurance types encompassing all lines of business.  Other on call duties include Help Desk support and handling of escalated issues (calls).  Off call work may include service issue research and resolution, reporting, special projects, etc. Responds to and resolves customer inquiries involving benefits, enrollment, claims, billing, authorizations and other issues.  Communicates benefits, policies, and procedures in clear and concise manner.  Documents call contact details, initiates workflow and follows-up at agreed upon time with results or status. Responds to Help Desk calls from junior representatives providing guidance, tools and information required to resolve customer’s issue.  Provides ‘in the moment’ coaching helping junior representative to develop skills, knowledge, and confidence to become more self-sufficient. Conducts offline research on complex service issues working with other MVP departments, external business partners, and MVP contracted service providers to resolve customer issues.  Completes research and follow-up in timely manner. Serves as mentor for junior staff members helping to refine knowledge and skills required to deliver first call resolution and a high-quality service experience. Handles complex, escalated service issues, attempting to diffuse emotional encounters and searching for solutions within the context of MVP’s policies and guidelines.  Knows when to raise an issue to a higher level. Recognizes trends and patterns in call volume, service issues, individual and team performance.  Initiates process improvement activities by Investigating new or critical service issues, determining root cause of the issue, and offering proactive solutions for improving the service experience.  Supports departmental goals (ASA, TAT, Quality, NPS, etc,) by achieving or exceeding individual objectives around availability, productivity, quality and issue resolution timeframes. Participates and/or initiates special projects and represents Customer Care Center on standing committees, departmental and corporate projects. Under direction of CCC Data Analyst, assists in preparation and execution of routine CCC reporting. Performs other duties as assigned. 

POSITION QUALIFICATIONS 

Minimum Education:  

• Post high school education (Associates degree, college courses) considered with relevant work experience
• High school diploma considered with call-center experience 

Minimum Experience:  

• Successful customer service experience and relevant office experience required
• Healthcare, health insurance experience required
• Call Center experience required 

Required Skills: 

• Broad and in depth knowledge of MVP’s product portfolio, benefits, policies, and procedures
• Familiarity with healthcare benefits and/or medical terminology
• Excellent oral/written communication and interpersonal skills
• Strong active listening, issue assessment and problem solving skills
• Ability to multi-task and work effectively in a fast paced, call center environment
• Strong organizational and follow through skills
• Demonstrated PC skills using Microsoft applications
• Ability to exercise discretion in handling confidential member information
• Passion for customer service and process improvement
• Self-directed individual 

Preferred Skills:  

• Bilingual (Spanish) a plus
• CAC