Provider Service Representative
: Job Details :

Title: Provider Relation Represenitive Pay: up to 50KLocation: Worcester MA Hybrid Overall Responsibility: To deliver high quality client service to doctors or doctor's office staff, members, community partners and plan sponsor representatives in a professional, respective and helpful manner. Process claims in a timely, accurate manner. Key responsibilities and accountabilities: Respond to inbound telephone calls, faxes and emails from doctors or doctor's office staff, and plan sponsor representatives in a timely and professional manner;Respond to inbound telephone calls, faxes and emails from members or member representatives in a timely and professional manner;Process dental claims on system for all clients;Process claim corrections from daily EDI reports;Document communications with doctors and doctor's office staff, and plan sponsor/employer representatives;Document communications with members and member representatives;Respond to claim inquiries from subscribers, doctors and plan sponsor/employer representatives in a timely and professional manner;Respond to benefit coverage inquiries from members and member representatives in a timely and professional manner;Respond to eligibility inquiries from subscribers, doctors and plan sponsor/employer representatives in a timely and professional manner;Maintain department productivity and quality expectations;Maintain knowledge of dental plan designs, exclusions, limitations and exceptions for each client;Adhere to all process and procedural guidelines;Any other duties as assigned#WETEMP TNG123