Provider Experience Specialist

Jefferson Health; Philadelphia (Philadelphia County); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Retirement plans

Tuition assistance

Job summary

Jefferson Health Plans is seeking a Provider Services Agent to support its provider network through a call-center based role. You will serve as a liaison, delivering timely, accurate information, and exceptional service while navigating multiple systems.

Strong communication, problem-solving, and customer service skills are essential for success. The role requires experience in handling provider inquiries, educating on processes and tools, and maintaining documentation with high accuracy.

Qualifications

• High School Diploma or GED or 3 years of equivalent work experience.
• 2 years of inbound call center experience.
• Strong organizational, analytical, communication, and interpersonal skills with the ability to effectively manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office applications and the ability to efficiently navigate multiple systems, databases, and applications while maintaining a high level of accuracy and attention to detail.
• Demonstrated problem-solving and customer service skills, including the ability to quickly identify issues, provide effective solutions, and de-escalate challenging situations.
• Dependable, adaptable, and goal-oriented professional with the ability to work independently and collaboratively while maintaining productivity in high-pressure environments.

Responsibilities

• Serve as a primary point of contact for providers, delivering accurate, professional, and timely support regarding eligibility, benefits, authorizations, claims status, network participation, and plan policies.
• Investigate and resolve provider inquiries by reviewing claims, researching issues, coordinating with internal departments, and facilitating appropriate escalations to ensure effective resolution.
• Educate providers on Jefferson Health Plans processes, programs, and self-service tools, including Provider Portal capabilities and available resources.
• Accurately document provider interactions and maintain compliance with departmental procedures, quality standards, and documentation requirements.
• Efficiently manage inbound and outbound communications while adhering to established protocols for information security, call handling, and cross-functional collaboration.
• Meet established performance, productivity, and quality standards while participating in ongoing training and professional development activities.
• Contribute to a positive provider experience by supporting operational initiatives, maintaining current knowledge of plan guidelines, and performing other related duties as assigned.

Skills

Strong communication

Problem-solving

Customer service

Multitasking

Interpersonal skills

Education

High School Diploma / GED or 3 years equivalent

Tools

Microsoft Office

CRM systems

Job description

Jefferson Health Plans is seeking a Provider Services Agent to support its provider network through a call-center based role. You will serve as a liaison, delivering timely, accurate information, and exceptional service while navigating multiple systems.

Strong communication, problem-solving, and customer service skills are essential for success. The role requires experience in handling provider inquiries, educating on processes and tools, and maintaining documentation with high accuracy.