Tivity Health, Inc.

  • Rep, Partner Experience

    Job Locations US-AZ-Chandler
    Job ID
    2018-1554
  • Description/Responsibilities

    The Partner Experience Representative (PER) answers inbound calls from members and providers, inputs data, and provides a high level of customer service always extending courtesy and professionalism.  The PER handles inbound member and partner service inquiries and problems via telephone and email while effectively recording communications accurately and consistently.  Calls may not always be routine, and may require deviation from standard screens, scripts and procedures.  PERs use a computerized system for tracking calls, information gathering, and/or troubleshooting.

    Inbound calls range from providers calling to obtain pre-authorizations, check on claim statuses and to dispute claim denials to members calling to find a provider. PERs provide information to our members and providers while providing high-quality customer service as a requirement.

     

    1. Efficiently and professionally handle heavy inbound call volume from members and providers.
    2. Identify, evaluate and prioritize caller needs, questions and concerns.
    3. Formulate plans of resolution and respond appropriately and efficiently.
    4. Maintain and/or restore caller satisfaction and partner with other teams as needed.
    5. Develop rapport with callers and adjust communication style appropriately.
    6. Use computer tools to accurately and thoroughly process and document information.
    7. Meet or exceed established contact center metrics for attendance, working rate, talk time and quality.
    8. Perform problem analysis and recommend resolutions to the callers in accordance with standard protocol.
    9. Offer provider referrals to members for Whole Health Choices program as requested.
    10. Accurately educate providers on appropriate claims and pre-authorization processes.
    11. Escalate issues internally and follow up on escalated issues to ensure timely resolution.
    12. Provide detailed explanation of fee schedule reimbursement rates to providers.
    13. Thoroughly explain credentialing requirements and status, as requested by providers.
    14. Assist in resolution with any “in-network” discrepancies between providers and health plan clients.
    15. Enter claims re-processing and adjustment requests after claim analysis and authorization, if applicable.

    Perform other duties as needed.

    Qualifications

    Education A high school diploma or GED is required.


    Experience One or more years of experience working in a customer service role.


    Knowledge / Skills

    • Strong customer service skills to support interaction with end users in a pleasant, professional, and courteous manner
    • Ability to articulate ideas clearly and concisely in a variety of settings, adjusting the message to match the audience
    • PC skills with proficiency using Windows and MS Office (Word and Excel)
    • Strong communication skills
    • Ability to empathize and understand the needs of the customer
    • Detail and process-oriented
    • Strong troubleshooting and problem-solving skills
    • Proficiency multi-tasking, prioritizing and meeting deadlines
    • Ability to handle business to business call types and resolve conflict


    Licenses / Certifications N/A

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