We enjoy the important work we do every day on behalf of our members.
Job Summary
Harvard Pilgrim Health Care is currently seeking a highly motivated individual to join our organization as an Employer Services Specialist. This role receives, resolves and/or triages front-line inquiries related to enrollment billing, claims and benefits questions from Employers, Brokers and Third Party Administers (TPA). He/she also acts as a resource and liaison to other departments within HPHC to facilitate resolution on operational issues for enrollment, billing, claims and benefits. Harvard Pilgrim Health Care is currently seeking a highly motivated individual to join our organization as an Employer Services Specialist. This role receives, resolves and/or triages front-line inquiries related to enrollment billing, claims and benefits questions from Employers, Brokers and Third Party Administers (TPA). He/she also acts as a resource and liaison to other departments within HPHC to facilitate resolution on operational issues for enrollment, billing, claims and benefits.
Job Description
Receives, resolves or triages all inquiries, issues and requests for information specific to the enrollment, billing claims and benefits received from Employers, Brokers & TPAs. Initiates, develops and maintains strong employer relationships. Recommends action plan if issues are identified or triages the issue to the appropriate department.
Tracks and records all account and customer contact through Oracle XRM Contact Management System. Ensures thorough research, follow-up and resolution of all issues, to avoid repeat calls.
Authorizes or coordinates approvals and denials of questionable or exception transaction requests received from employer groups or other external customers based on HPHC guidelines and in scope of responsibility.
Coordinates Urgent Enrollment and resolutions of enrollment discrepancies (e.g. failed transactions),
Ensures new employer groups, enrollments and changes are set-up, processed and entered into the system in a timely manner by educating employers on Enrollment options, requirements and processing time frames. Reaches out to new accounts to perform introductory call and educates Employers about online options; HPHConnect, Online Billing & information available on the Public Web.
Monitors contractual agreements and performance guarantees with accounts to ensure compliance.
Provides reporting (e.g., Schedule A) and documentation as requested to accounts.
Fosters cross-departmental collaboration/coordination to achieve department and service level goals.
Coordinates Out-of-Area, handicap and student processes.
Requirements
Health Care Experience
Customer Service Experience
High School Diploma, BA/BS preferred or related experience
2 years customer and/or account service experience required
Resilient, collaborative, flexible, innovative.
What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!
