Senior, Provider Service Specialist

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

Job Summary

Under the general direction of the Provider Service Operations Support Supervisor, the Senior Provider Services Specialist is responsible for direct support for the Provider Services team (which includes all product lines of business: HPHC Commercial [focus on], THP Commercial, Public Plans, Senior Plans). The Specialist’s primary function is to service specialty queues, assist with administrative tasks, provide coaching/feedback to service center outsourcing vendor team and their Supervisors and Team Leads as trends which are identified through inquiries to the support help desk. In addition, the Specialist is responsible for supporting our relationship with the outsourced Provider Services service center vendor.

Key Responsibilities/Duties – what you will be doing

Main Functions:

• Primary function is to receive and respond to a moderate volume of incoming calls to service HPHC National Accounts. Provide accurate and thorough information on plan benefits, eligibility, claims and authorizations. Provide Provider Service model flexibility/scalability, the foundation for interim and future opportunities.
• Answer inquiries to the help desk support team and provide coaching/feedback to the call center outsourced vendor as trends are identified through the interactions.
• Provide support for the help desk team to ensure the Provider Services service center vendor has readily available and adequate assistance during all shifts.
• Manage and track email requests and escalated issues as well as assist in resolution.
• Participate in various company/departmental initiatives, projects, or committees as assigned by management.  This may include process improvement initiatives and participating on cross-functional teams.  Flexibility to expand roles and responsibilities as deemed necessary.
• Ensure issues are addressed accurately and in a timely manner for all escalated provider issues for all lines of business.
• Identify trends and issues that are primarily reported by the Provider Services service center vendor, and report and escalate as needed.
• Act as a resource to Provider Services for guidance with investigating and communicating operational issues. 

Communication (Written and Verbal):

• Proficient in writing clear and concise correspondence.
• Communicate expectations and provide direction in a clear and concise manner.
• Provide current information that helps staff to solve and/or anticipate problems.
• Educate the Provider Services call center vendor as needed if something is mishandled or if they would benefit from a reminder of a certain process or workflow.
• Communicate updates, issues, and workflows to the overall Provider Services vendor as well as any partnered departments.

Decision-Making and Problem Solving:

• Display maturity, professionalism and diplomacy when dealing with sensitive issues.
• Consistently adhere to company and department guidelines.
• Proactively identifies process improvement opportunities.

Leadership:

• Coach, mentor, recognize and share feedback to improve agent performance and our provider experience.
• Ensure staff has the tools, skills, and knowledge to perform job functions.
• Actively participate in team meetings.
• Analyze auditing results and quantitative statistics and data to identify and improve individual, team and department performance and improve provider and the Provider Services call center vendor satisfaction.

Passion for Service:

• Inspire and motivate staff to deliver exceptional service to Providers through example, innovation, risk taking and a willingness to explore new ideas.
• Find and share creative solutions to provider issues and