Position Overview

The Lead Provider Services Representative is the most senior level call center representative and possesses a genuine desire and commitment to assist customers and support the mission, vision and values of Neighborhood. The Lead Rep assumes the most complex work within the department and having the experience required to appropriately meet the needs of our providers.

Duties and Responsibilities

Responsibilities include, but are not limited to the following:

Provides accurate and thorough interpretation of Neighborhood Health Plan benefits, claim processes and eligibility to our providers and staff.

Research, review and respond to complex provider inquiries received in the call center via escalation process including the following:

o Claims related issues

o Submitting and tracking application support tickets related to provider issues

o Benefit Clarifications

o Provider Education inquiries from Agents

o Contact Providers for follow up and/or closure to escalated issues as necessary

Support call center staff using applied knowledge of Neighborhoods benefits, policies and procedures

Foster independence among call center staff by encouraging available information and resources

Identify issues/trends to reduce provider escalations, identify training opportunities and recommend process improvements

Assist Supervisors with ongoing training for call center staff

Collaborates with other departments on issue resolution

Ability to multitask between floor support and researching escalated provider issues

Represents Neighborhood to internal and external customers in a professional manner

Answering inbound provider calls as needed

Performs other assigned tasks as needed

Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Core Company-Wide Competencies:

• Communicate Effectively
• Respect Others & Value Diversity
• Analyze Issues & Solve Problems
• Drive for Customer Success
• Manage Performance, Productivity & Results
• Develop Flexibility & Achieve Change

Job Specific Competencies:

• Judgement & Decision Making
• Plan & Organize
• Collaborate & Foster Teamwork
• Attention to Detail & Quality Improvement
• Create & Innovate

FDR Oversight

• N/A

Travel Expectations

• Attends corporate meetings and events as required

Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

Qualifications

Required:

• High school degree
• Minimum of 18 months’ customer service and/or call center experience
• Must be able to exercise excellent judgment and be effective working autonomously and as part of a team
• Exceptional listening skills and communication skills
• Problem solver with strong attention to detail
• Extensive knowledge of all Neighborhood products and services, including all key internal departments and external vendors
• Must be knowledgeable of resources available within the organization to resolve both internal and external problems and concerns
• Strong information management skills including the ability to organize information, identify subtle and/or complex service delivery issues that impact customers and the ability to articulate and pursue solutions to problems impacting service
• Strong multitasking skills
• Knowledge of HIPAA standards
• Ability to work fully remote

Preferred:

• 2-3 years customer service and/or call center experience
• Strong knowledge/familiarity of Neighborhood core systems
• Superior written/communication skills
• Superior organizational skills
• Intermediate Microsoft Excel skills