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Provider Relations Specialist

Provider Relations Specialist

Trident Global Assistance Inc.Toronto, ON, Canada
30+ days ago
Job type
  • Full-time
Job description

Job Description

Job Description

SUMMARY

Reporting to the Director of Global Strategy, the Providers Relations Specialist (PRS) will act as a liaison between the Claims Department and the Health Care Providers or Preferred Providers Networks (PPO), properly identify and apply discounts through networks that providers belong to and negotiate discounts to maximize on cost savings with accuracy and efficiency.

PURPOSE

The purpose of this position is to support the Claims Department with cost savings to medical claims.

Responsibilities and Duties

  • Coordinate and support the Claims Department team
  • Answer questions from health care providers about service contracts, available in-network / out of network services, and billing procedures.
  • Request invoices as well as medical records from health care providers or PPO Networks if they are not received in a timely manner
  • Record Invoices and medical records and all pertinent information to the claims system under the appropriate claim ID
  • Establish and maintain relationships with health care providers and networks to ensure the successful completion of discounted invoice(s)
  • Negotiate a reasonable settlement to inflated medical invoice
  • Review Billings against Medicare rates and identify unbundling of charges
  • Secure a signed agreement with health care providers with clear and concise terms
  • Generate and provide regular status reports of high-dollar claims, including trends, challenges, and outcomes to the Director
  • Assist with claims-related projects and reporting as needed
  • Perform other duties as assigned within the scope of responsibilities and requirements of the job

Core Competencies

1. Work Ethic

  • Punctual, have excellent attendance and be presentable and appropriately dressed
  • Respectful of management and company rules
  • Honest, friendly to fellow staff members and clients
  • Self-motivated and positive attitude
  • Fully productive and flexible to seasonal, monthly and daily targets
  • Puts company objectives above personal objectives
  • Trustworthy

    • 2. Communication

  • Professional conduct
  • Excellent English written and oral (French when needed)
  • Good telephone manner, listens and problem solves effectively
  • Communicates effectively and in a business-like manner to a diverse range of people; clients (particularly those who speak English as a second language) and employees of Trident Global Assistance.

    • 3. Teamwork

  • Supportive of fellow staff members
  • Participates in department and company functions
  • Understands and works towards departmental goals

    • 4. Technical

  • To pick up new concepts quickly
  • To be precise when following policies and procedures
  • Accurate and thorough
  • To meet deadlines set through regular work or through special circumstances
  • To be organized
  • To exhibit good time management
  • To see active cases through to satisfactory completion
  • To be goal and results oriented
  • To pay attention to detail

    • 5. Customer Service

  • Helpful to customers externally and internally
  • Takes ownership of clients’ requirements
  • Handle customer objections effectively

    • Certificate or Licensing

  • May require Adjusters License for BC and Alberta

    • Physical Demands

  • Use computers for long periods
  • Work in a busy and crowded work environment
  • Work patiently with irate customers
  • Accommodate shift work

    • Job Qualifications

  • Background in the health care industry or the equivalent in the travel insurance industry
  • Familiarity with the USA Health Care System and practices
  • Exceptional negotiation skills
  • Experience as a client service representative
  • Exceptional communication skills (verbal and written)
  • Customer orientation and ability to adapt / respond to different types of characters
  • Ability to multi-task, prioritize, and manage time effectively
  • High school diploma or equivalent

    • Bilingual in Spanish speaking candidate an asset

    This is NOT a remote position, must be eligible to work in Canada and attend this job in person in the Etobicoke office

    Company Description

    Be part of a dynamic team and make an impact in a fast-growing travel insurance company.

    Company Description

    Be part of a dynamic team and make an impact in a fast-growing travel insurance company.