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Provider Service Advocate (Virginia Beach, VA)

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Keywords:
Call Center, Customer Service, CSR, Provider, Provider Relations, health care, insurance, Medicaid, Medicare, Dual Eligible, Healthcare, Managed Care, Agent

Summary:

Join a team of Patient Service Advocates committed to transforming the health care experience for health care providers who serve our most vulnerable members—the Dual Eligible population. These patients receive both Medicare and Medicaid benefits, and our team of Advocates are a critical component in supporting the health care professionals who deliver their care under those programs.
Patient Service Advocates are seasoned Medicaid/Medicare and customer service experts with experience in providing first class B2B service to professionals. Advocates are focused on understanding and meeting the needs of our providers by connecting with our mission and vision in their daily work activity. You will have the opportunity to be a Subject Matter Expert on Dual eligibility for our network of healthcare providers while working with them over the phone to resolve claims issues. Advocates will use their analytical skills to identify issues and proactively engage to solve problems during the call, all while providing “concierge level” service to the providers. Advocates should be able to anticipate the needs of our providers, demonstrate good listening skills, and practice strong verbal and written communication skills to help influence our providers resulting in an amazing customer experience. You will be the credible expert who leads these providers through the complex maze of Dual Eligibility allowing them to focus on providing great care to our members.
Amerigroup, a member of the WellPoint family of companies, is focused on serving Medicaid, Medicare and uninsured individuals and families. Nationwide, we serve one out of every 29 Medicaid recipients and one out of every 28 children covered by CHIP. WellPoint is one of the nation's leading health benefits companies and a Fortune Top 50 company.

At Amerigroup and WellPoint, we are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine.

This position will be located in our National Call Center in Virginia Beach, VA and is planned to start in November 2013.


Responsibilities:
1. Provides telephonic assistance to members, providers, billing agencies and/or prospective members for assigned products.
2. Assists with benefit and eligibility explanation, claim issues, network changes, customer service issues and/or terminations.
3. Prepares correspondence, maintains phone and contact logs, and documents call details as appropriate.
4. Identifies trends and root causes of call inquiries or issues, and recommends improvements to internal processes and training to department leadership.
5. Understands and accurately interprets product benefits, applicable state and federal guidelines/regulations, and department policies.
6. Assesses callers needs, makes appropriate recommendations or action, and aims for first call resolution.
7. Resolves complex or escalated issues of callers by thoroughly researching cause of error.
8. Depending on assigned role, may be responsible for:
• Handling complex adjustments to claims.
• Completing and submitting required enrollment documentation.
• Initiating outbound call campaigns.
• Assisting more junior representatives.
• Working with other departments to resolve issues.
9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education
Required:
• High school diploma or GED
Preferred:
• Associate’s degree in business, health care or related field.

Years and Type of Experience
Required:
• Five years of customer service or call center experience.
Preferred:
• Previous managed health care call center experience

• Previous claims processing experience

Language Skills
Required:
• English
Preferred:
• Other languages as determined by business need.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment-Intermediate
• Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
• Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
• Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Communication Skills: Verbal, Written and Call Handling
• Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
• Demonstrates skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.
• Ability to prepare, edit and convey a variety of messages including presentations, training materials and updates. Ability to handle escalated issues to diffuse concerns through verbal and written messages.

Heath Care Industry Terminology
• Ability to understand basic health care industry terms. Ability to understand how an insurance claim works and use the explanation of benefits to explain details to providers.

Read, Interpret and Apply Information
• Ability to read and comprehend information and provide detailed explanation to the business partner or customer that is accurate and appropriate.
• Ability to research information using available resources and determine where gaps in information exist to seek other sources.

Medical Terminology and Anatomy
• Understand basic medical terminology in order to review and understand claim information.

PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to Amerigroup travel policies and procedures. CB1

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