Provider Services Representative

Position Description

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The Provider Service Representatives are the front-line team at Capital BlueCross (“CBC”) and are responsible for handling all provider inquiries through multiple channels (i.e., phone, web, electronic, and/or face-to-face) by using material and tools with accuracy and precision. This incumbent will be responsible for effectively presenting and discussing our products and services, creating and maintaining positive relationships and for exceeding quality, productivity, and ultimate performance goals. This incumbent will be required to initially attend a training class in addition to ongoing periodic refresher trainings to service our providers as business needs permit.

Responsibilities and Qualifications

Duties and Responsibilities:

• Manage telephone, electronic, and face-to-face interactions professionally, efficiently and with excellent communication skills
• Effectively present and discuss the products and services to external and internal providers with integrity and understanding and accuracy with every interaction
• Focus on provider retention through first call resolution of concerns
• Establish and maintain positive relationships with providers on behalf of the company by taking personal and complete responsibility for each provider interaction
• Ensure all providers’ needs are completely met, timely, without elevation if possible
• If business needs permit, support the efforts of CBC sales representatives by conducting onsite and/or community-based educational meetings
• Large emphasis on quality, productivity, adherence, handle time, and not negatively affective and jeopardizing CBC provider relations, internally and externally
• Complete ongoing training to stay abreast of products, services and policy changes
• Improve quality of work on a daily basis by learning and employing new skills or adapting previous processes to mirror the fit-for-excellence company culture
• Recognize, document, and alert supervisors of trends in provider calls
• • Conduct self in a manner consistent with the values of the organization

Knowledge:

• Experience with provider interaction preferred, but not required
• Demonstrates ability to understand and interpret detailed policies and procedures and to be able to apply them to various situations. This includes thorough understanding of CBC’s responsibility to maintain privacy of Protected Health Information as required by the Health Insurance Portability and Accountability Act.
• Demonstrates ability to work independently, be flexible and react appropriately to changing job assignments and work environments.
• Demonstrates ability to communicate effectively and professionally both verbally and in writing with all levels of internal/external personnel in order to respond to customer inquiries ranging from routine to complex and involving sensitive subject matter.
• Ability to use telephone equipment systems such as Interactive Voice Response and Automated Call Distribution.
• Familiarity with the utilization of a PC and various software such as Microsoft Office Suite.

Education and Certifications:

• Must have a High School Diploma or GED
• Bi-lingual (Spanish) a plus

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.       And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.