What are the responsibilities and job description for the Provider Services Representative II position at Summa Health?
SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Works to ensure and improve provider satisfaction by assisting provider offices by answering questions, addressing concerns, researching/solving problems, and educating on all aspects of benefit plans and pharmacy riders.
Educational Requirements
High school diploma/GED or may substitute with 1 year of like experience.
Required Experience
1 years performing same or similar responsibilities. Relevant experience includes: Customer service or call center experience in any industry, or provider service or provider billing experience.
Required Licenses and/or Certificates
None required.
Software and Data Entry Requirement
None Required.
SKILLS AND ABILITIES
Communication
High: ability to communicate instructional and operational information verbally and in written form that may include correspondence, reports, instructional materials, system designs; ability to provide instruction and guidance required to supervise day-to-day departmental operations; ability to interface with internal staff, mid-upper management professionals, general public.
Analytical
High: collecting, analyzing data from diverse sources; making recommendations and/or conclusions based on analyses; developing financial, data processing technical reports, procedures, systems that usually affect one department. Proofreading completed work to find and correct errors. Requires excellent attention to detail.
Other Skills and Abilities
1. Balance the need for decisive, professional demeanor with warm, non-confrontational customer-first attitude and project a positive, respectful and cooperative disposition. Ability to effectively deal with a diversity of people.
2. Maintain knowledge of SummaCare and current industry issues.
3. Maintain and demonstrate knowledge of all quality standards for Provider Support Services.
4. Project empathy, confidence, proper tone and service-oriented attitude over the phone.
5. Complete customer service training offered by SummaCare (e.g. All-Star Certification, MAGIC) within 1 year of hire/transition into position, and on an ongoing basis.
6. Organize and manage time to accurately complete tasks within designated time frames in fast-paced environment.
7. Maintain current knowledge of and comply with regulatory and company policies & procedures.
8. Maintain confidentiality of member health and business information.
9. Flexible: ability to adjust work hours to meet business demands.
Physical Effort and Dexterity*
1. Sit for prolonged periods of time.
2. Bend, stoop, and stretch.
3. Lift up to 25 pounds.
4. Manual dexterity to operate phones, computer, and standard office machines.
Visual Acuity, Hearing, and Speaking*
- Candidates whose disabilities make them unable to meet these requirements will still be considered fully qualified if they can perform essential functions of job with reasonable accommodation.
Scheduling
Occasional overtime work required during peak business periods as scheduled by supervisor. Occasional travel which may require use of personal auto to attend meetings, conferences, workshops, and/or seminars.
Safety Hazards and Environment
Minimal hazards. General office working conditions.
Equal Opportunity Employer/Veterans/Disabled
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
Salary : $19 - $23