11 days old

Provider Services Specialist

EMPLOYERS
Glendale, CA 91201
  • Job Code
    116954193

Location: Glendale, CA
Job_Code: 4834
# of Openings: 1

As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work!

We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS®!

Headquartered in Reno, Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees.

We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other!

At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As "America's small business insurance specialist", we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career.

General Summary:

Under moderate direction of the Provider Services manager, the Provider Services Specialist performs duties of operational support for EMPLOYERS national workers' compensation provider network and bill review. Through report production and analysis, will identify opportunities to improve economic and medical outcomes under the guidance of the Provider Services Manager.

Essential Duties and Responsibilities:

  • Performs static reports (monthly and year-to-date) to measure provider network performance based on frequency and expense of medical services.
  • Logs and responds to all provider nomination inquiries for participation in EMPN.
  • Participates in data analysis on all measures of economic and medical outcomes, identifying trends, variances and initiatives for further investigation.
  • Conducts periodic review of policyholder sites to assess growth in underserved areas.
  • Tests EMPLOYERS accessibility standards' compliance with periodic production and review of provider directories.
  • Maintains network provider inventory identifying number of providers per county/per state by type of provider and specialty.
  • Conducts periodic quality assurance audits of the medical provider listings for accuracy of information.
  • Conducts periodic contact of providers via phone or e-mail to confirm the provider's accessibility to new or referred injured employees.
  • Logs all complaints and/or grievances from our customers concerning any issue of potential variance to operating procedure standards of the networks.
  • Performs multiple tasks with varied levels of priority and deadlines requiring the project management process.
  • Reviews and responds to incoming mail, emails, telephone calls, and fax transmissions from customers with notification of supervisor on those matters requiring elevation of attention and action.
  • Ensures timely compliance with all policy and procedures.
  • Prepares worksite panels for new and renewal policies annually as well as worksite posters for policyholders, sales, claims, and administration.
  • Provides support for the Provider Services Department
  • Assists in trouble shooting/problem solving issues as they arise.
  • Maintains confidentiality of all data and records.
  • Conducts business at all times with the highest standards of personal, professional and ethical conduct.
  • All other duties as assigned or as situation dictates.

    Job Requirements:
  • Strong oral and written communication, listening, interpersonal, customer service and telephone skills.
  • Proficient in the use and knowledge of MS Office Word software, with the ability to type at a minimum of 35 wpm.
  • Proficient in the use and knowledge of MS Office Excel software, with the ability to create and modify spreadsheets.
  • Proficient in the use and knowledge of MS PowerPoint software, with the ability to create and modify presentations.
  • Demonstrated ability to understand and adhere to statutes, regulations and company policies and practices.
  • Demonstrated skill in working independently with moderate direction, multi-tasking skills, determine the relative importance of each, adhere to deadlines, and complete assignments accordingly.
  • Good analytical, problem solving and decision-making skills and be able to deal with people in difficult situations.
  • Ability to maintain confidentiality.

    PREFERRED, BUT NOT REQUIRED

  • Bachelors (or higher) degree in a health services related field.
  • Experience in the use of Excel Pivot Tables.
  • Experience in data management (Oracle, SAP and/or COGNOS)

PI116954193

<br/><b>Location:</b> Glendale, CA<br/><b>Job_Code:</b> 4834<br/><b># of Openings:</b> 1<br/><br/>As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! <br> <br> We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! <br> <br> Headquartered in Reno, Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. <br> <br> We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! <br> <br> At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As "America's small business insurance specialist", we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. <br> <br><strong> General Summary: </strong><br> <br> Under moderate direction of the Provider Services manager, the Provider Services Specialist performs duties of operational support for EMPLOYERS national workers' compensation provider network and bill review. Through report production and analysis, will identify opportunities to improve economic and medical outcomes under the guidance of the Provider Services Manager. <br><br><strong> Essential Duties and Responsibilities: </strong><br> <ul> <li> <br> Performs static reports (monthly and year-to-date) to measure provider network performance based on frequency and expense of medical services. <br> </li><li> Logs and responds to all provider nomination inquiries for participation in EMPN. <br> </li><li> Participates in data analysis on all measures of economic and medical outcomes, identifying trends, variances and initiatives for further investigation. <br> </li><li> Conducts periodic review of policyholder sites to assess growth in underserved areas. <br> </li><li> Tests EMPLOYERS accessibility standards' compliance with periodic production and review of provider directories. <br> </li><li> Maintains network provider inventory identifying number of providers per county/per state by type of provider and specialty. <br> </li><li> Conducts periodic quality assurance audits of the medical provider listings for accuracy of information. <br> </li><li> Conducts periodic contact of providers via phone or e-mail to confirm the provider's accessibility to new or referred injured employees. <br> </li><li> Logs all complaints and/or grievances from our customers concerning any issue of potential variance to operating procedure standards of the networks. <br> </li><li> Performs multiple tasks with varied levels of priority and deadlines requiring the project management process. <br> </li><li> Reviews and responds to incoming mail, emails, telephone calls, and fax transmissions from customers with notification of supervisor on those matters requiring elevation of attention and action. <br> </li><li> Ensures timely compliance with all policy and procedures. <br> </li><li> Prepares worksite panels for new and renewal policies annually as well as worksite posters for policyholders, sales, claims, and administration. <br> </li><li> Provides support for the Provider Services Department <br> </li><li> Assists in trouble shooting/problem solving issues as they arise. <br> </li><li> Maintains confidentiality of all data and records. <br> </li><li> Conducts business at all times with the highest standards of personal, professional and ethical conduct. <br> </li><li> All other duties as assigned or as situation dictates. <br><br><strong> Job Requirements: </strong><br> </li><li> Strong oral and written communication, listening, interpersonal, customer service and telephone skills. <br> </li><li> Proficient in the use and knowledge of MS Office Word software, with the ability to type at a minimum of 35 wpm. <br> </li><li> Proficient in the use and knowledge of MS Office Excel software, with the ability to create and modify spreadsheets. <br> </li><li> Proficient in the use and knowledge of MS PowerPoint software, with the ability to create and modify presentations. <br> </li><li> Demonstrated ability to understand and adhere to statutes, regulations and company policies and practices. <br> </li><li> Demonstrated skill in working independently with moderate direction, multi-tasking skills, determine the relative importance of each, adhere to deadlines, and complete assignments accordingly. <br> </li><li> Good analytical, problem solving and decision-making skills and be able to deal with people in difficult situations. <br> </li><li> Ability to maintain confidentiality. <br><br><strong> PREFERRED, BUT NOT REQUIRED </strong><br><br></li><li> Bachelors (or higher) degree in a health services related field. <br> </li><li> Experience in the use of Excel Pivot Tables. <br> </li><li> Experience in data management (Oracle, SAP and/or COGNOS) <br> </li> </ul> <br> <br/><br/> <img src="https://analytics.click2apply.net/v/xW4QrAfmRZNqco6Nux2YD"> <p>PI116954193</p>

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Posted: 2020-01-09 Expires: 2020-02-09

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Provider Services Specialist

EMPLOYERS
Glendale, CA 91201

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