Provider Relations Representative
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Newark, DE 19713
The Insurance/Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Responds to general insurance and health policies questions I accordance with state and federal laws. Provides expertise to investigate claim characteristics that do not match policy provisions. Responds to provider inquiries to avoid appeals. May need to schedule meetings with providers to resolve problems/issues. Provides directions for enrollment issues as well as claim issues. Good telephone communication as well as able to handle production items
· Participates in the identification, documentation, analysis and validation of basic business processes
· Review data and make independent decisions with some direction.
· Learn policies and procedures as they relate to the contract.
· Researches components of solutions to claim problems.
· Learn how to handle escalated issues from the customer.
· Supports requirements of business unit.
· Learn internal processes tools.
· Works effectively in a team environment, including call center
· Ability to take direction and follow general instructions.
· Manage assignments with limited supervision.
· Manage requests from customers and leaders.
Education and Experience Required:
· Bachelor’s degree in insurance, healthcare or related field or High School Diploma or equivalent; may hold 2 year post-high school Degree (insurance, healthcare or related field).
· Typically, 1-3 years of working experience in call center and/or healthcare setting
· Travel, limited 1-3 days a month
Knowledge and Skills:
· General healthcare knowledge of commercial and government insurance programs.
· Basic understanding of healthcare related technologies.
· Basic knowledge of project management, research and problem resolution techniques.
· Ability to plan and meet deadlines.
· Ability to communicate effectively with both internal and external customers.
· Good written and verbal communication skills.
· Ability to understand instructions and accomplish tasks.
· Ability to work in a team environment/ and call center
· Good business and technical writing skills to ensure that all documentation meets required standards.
· Advanced computer skills to minimize training time for organization specific software.
· Good research skills.
DXC Technology is EEO F/M/Protected Veteran/ Individual with Disabilities