Member and Provider Services Representative - Premier Administrative Solutions

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Customer Service | Member and Provider Services Representative  

Clearwater, FL

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• VERY competitive pay/compensation package
• Monthly metric bases bonuses - up to $800!
• NO selling, NO weekends
• Monday - Friday - 9:30 AM to 6:00 PM
• Paid Training, Health, Dental, Vision, and Life Insurance as well as Paid Time Off and Paid Holidays! 

This is a fun, challenging, and motivating work environment with a career path and opportunities for growth!

Summary:

Premier Administrative Solutions (PAS) is a Third-Party Administrator (TPA) which 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 calls, 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 is provided the tools to do so.  The number of MPSRs assigned to a team will vary based on the size of the client and volume of calls and correspondence related to the client.

Essential Duties and 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 30 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 5 calls per week for MPS Representative will be audited by the Quality Audit Team 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.
• 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.
• Ensuring that Company policies and procedures related to HIPAA Privacy and Data and System Security are maintained at all times.
• 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.           

Primary Performance Expectations:

Performance review for each MPS Representative is ongoing, with formalized reviews quarterly.  The results of the quarterly reviews will determine increases in responsibility, compensation, and incentive compensation.  Performance expectations or goals are as follows:

Team Telephone Service Levels

• Service Level: Minimum of 80% of calls reach a live Member and Provider Service Representative within 30 seconds.
• Average Speed to Answer: The average speed to be answered for all calls will be less than 30 seconds.
• Abandon Rate: For all calls reaching the Team’s phone queues, less than 5% will result in the caller hanging up prior to reaching a Representative.

Individual Production Level

• Handle a minimum of 275 MPS transactions per week. A transaction is defined as an inbound call, outbound call where the intended target for the call is reached, or a written response to inbound mail or e-mail.

Quality Level

• A minimum of 5 calls per week will be audited and the overall Team score must average a minimum of 95% or higher.

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Customer Service | Member and Provider Services Representative  

Clearwater, FL

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Qualifications and Competencies:

• A minimum of at least 6 months working in an inbound Customer Service Center focused on health insurance or provider billing. If no health insurance experience, at least 12 months of experience working in a high-activity inbound Call Center.
• 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.

Education and/or Experience:

• High school graduate or equivalent.
• Knowledge of medical terminology, billing, claims and the health insurance industry is preferred but not required.

Certificates, Licenses, Registrations:

• None

Computer Skills:

• Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook

Environmental Factors/Physical Demands:

• Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping, and lifting up to thirty (30) pounds.

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Customer Service | Member and Provider Services Representative  

Clearwater, FL

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