Providence Health & Services Customer Service Specialist - Health Plan in Beaverton, Oregon
Providence St. Joseph Health is calling a Customer Service Specialist - Health Plan to Murray Business Center in Beaverton, OR.
This position is in a fast-paced call center environment, each specialist handles an average of 70-100 inbound calls a day.
This is a full time position, the hours of operation are Monday - Friday 8am-5pm.
In this position you will have the following responsibilities:
Research and respond to member, provider, employer group and other internal and external questions, concerns, needs. Provide education to both members and providers as appropriate.
Function as a liaison, knowledge source and problem solver with multiple departments. Research, investigate and triage customer issues of concern and dissatisfaction.
Advocate for the customer. Explain benefits in a detailed and courteous manner so they are understood.
Educate members to promote utilization of products and services to their full advantage, and to optimize the value of their healthcare dollar.
Facilitate resolution of member or provider’s issue in a timely, efficient and professional manner
Maintain a comprehensive level of industry knowledge of insurance benefits, provider networks and contracts, health engagement and delivery models, and internal process flows.
Required qualifications for this position include:
High School or GED.
2 years experience in a high pressure customer facing environment with a proven track record of learning and applying complex concepts.
Exceptional customer service skills, with the ability to adapt, educate, and empower a variety of customers, ranging from the highly educated to the most vulnerable in society.
Demonstrated data entry skills and PC processing skills in a Window based environment.
Demonstrates ability to analyze and successfully solve complex problems, exercising sound judgment at point of service
Maintain knowledge of regulatory compliance and government programs, policies and procedures relating to claims adjudication, medical management, enrollment, provider networks, authorization, and referral requirements.
Knowledge of web based applications, with the ability to educate and support member customers and provider partners in the use of online tools.
Maintain knowledge of various Providence and community resources as well as State and Federal assistance programs.
Preferred qualifications for this position include:
- Basic medical terminology, CPT, ICD9-10 coding knowledge
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Health Plan/Insurance Nursing
Req ID: 210672