Job Purpose
To serve as a competent courteous and proactive point of contact for members and providers by handling inquiries in-person by phone and email in accordance with company standards ensuring timely follow-up and resolution that meets the expectations of members providers and internal teams while supporting high-quality service delivery
Key Activities Responsibilities and Accountabilities
- Conduct surveys to monitor clients and providers satisfaction analyze feedback trends and suggest recommendations for service enhancements
- Document and analyze recurring provider and client issues sharing insights with MSU management to address root causes and improve service processes
- Coordinate with providers members and internal teams to resolve service issues and ensure smooth operational support
- Assist in reviewing and improving the healthcare provider network including strategic providers
- Prepare and present accurate reports to support management decisions and fulfill reporting requirements
- Verify members health insurance policies and provide guidance throughout the process including admissions medical and lab requirements radiology claims etc
- Establish and maintain strong relationships with providers insurance directors through regular front-line visits addressing concerns and feedback and promoting a positive provider image to support and enhance the partnership framework
- Ensure provider compliance with agreed service standards and support their staff through coaching and training on ART s services
- Support Point of Care operations and handle operational cases generated from assigned sites and network hospitals
- Adhere to service procedures and maintain in-depth knowledge of departments provider networks and company services to handle member inquiries confidently and accurately
- Resolve member complaints effectively within delegated authority to ensure satisfaction with minimal need for escalation
Job requirements
Academic Qualifications and Experience : Bachelor s degree in insurance, Healthcare management, or related fields is required. 0-2 years of related experience.