Employer: Guardian Life Insurance
Join us for an exciting career with the leading provider of supplemental benefits!
Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
The Provider Services Representative (PS1) is tasked as part of the Provider Support Operations Department, to be the liaison between Avesis and the participating provider network. The Provider Services Representative (PS1) will be responsible for coordinating efforts with Provider Relations (Field Representatives) to build and nurture positive relationships with the Avesis eye care/dental/hearing provider community to include but not limited to best in class provider education and training, issues research and projects.
Essential Job Functions:
- Provider Services encompasses several diverse provider administrative duties to improve the Avesis provider experience including direct provider engagement and training, network adequacy monitoring and resolution of claim payment issues
- Conducts provider outreach by providing training and guidance to enable Avesis network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of available tools
- Responds to general provider contract inquiries, provider education and non-routine claim issues and may research, analyze and recommend resolution for provider disputes
- Work closely and coordinates with Avesis Claims, Customer Service, Utilization Management, Credentialing, Recruitment, Account Management and other staff to investigate Provider concerns about billing issues and their root causes to develop operational solutions
- Understanding of health insurance claims, as well as an ability to analyze data to resolve provider service issues
- Working knowledge of credentialing process
- Investigate and respond to complex provider related issues and initiate change of provider related database information
- Knowledge of and ability to use various computer programs such as Microsoft Office including spreadsheet, word processing and presentation software and programs/systems utilized in data analysis
- Ability to prioritize and organize a diverse workload required
- Excellent verbal and written communication and effective listening skills required
- Other duties as assigned
Qualification Requirements:
- High School diploma or equivalent (Prefer Associates Degree or higher); experience may substitute for education
- Previous dental/vision/hearing experience
- Knowledge of health plan operations
- Strong skills in using Microsoft Office applications and other windows-based applications
We Offer
- Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
- Competitive compensation package.
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
- Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.