Providence St. Joseph Health is Service Specialist 1 (Full-Time, FTE 1.0, Days) to our Murray Business Center location in Beaverton, OR.
We are seeking a Service Specialist to be responsible for the first line of communication with a variety of customers, including existing and potential members, providers, and employers. Will provide detailed benefit, eligibility and premium information on a broad portfolio of products, assist members in selecting medical homes and primary care physicians, educate members and providers in the appropriate use of health plan and clinic services, research and respond to claims and authorization inquiries, and resolve customer issues and concerns.
Effectively establishing priorities in an environment of competing urgent demands.
Develop a comprehensive knowledge of claims adjudication, applying concepts and theory in the absence of hands on claims training/experience.
Maintain detailed knowledge of Health Plan products, provider networks and funding arrangements, community resources, health care industry trends, CMS & DCBS rules and regulations.
Develop and maintain a comprehensive knowledge in a complex and rapidly changing environment required to support the Affordable Care Act and Cover Oregon requirements; in addition to a growing number of unique administrative service arrangements.
Effectively handle angry members or providers by identifying the source of their dissatisfaction, diffusing their anger, and resolving the situation which may require coordination with multiple individuals or departments.
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.
Required qualifications for this position include:
H.S. Diploma or GED
At least two (2) years of experience in a high pressure customer facing environment with a proven track record of learning and applying complex concepts.
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.
Providence Health & Services