Servicing Support Specialist
Canton, Massachusetts, Us
As a Servicing Support Specialist I was responsible for analyzing internal inquiries of complex issues that come from multiple areas of the business. I work directly with the Service Department to provide education and feedback to the direct reports of Member and Provider Services. I am a subject matter expert on Tufts Health Plan benefits, claims processes, eligibility guidelines, and provider contractual agreements. I maintain up-to-date knowledge on regulations and Tufts Health Plan guidelines and processes in order to advise internal partner departments on complex customer inquiries and to facilitate or communicate problem resolutions with a focus on claim adjustment. On a weekly basis I work with contracting Providers to drive speedy resolution of outstanding issues.• Designed and created training processes and material for the team and trained new team members.• Served as the technical and functional product expert for 90-person call center staff, educating staff on benefits, claims, and internal workflows.• Consulted 5 departments, including call center, claims, mental health, benefits, and appeals, on claims inquiries to make adjustments when necessary.• Enforced contracts and billing guidelines with providers to delicately resolve potential conflicts.• Represented department as an Appeals Committee Member to review, debate, and guide resolution of 75+ monthly cases submitted by members.• Identified emerging trends impeding first call resolutions and created job aids and process improvements to resolve issues, improving overall department performance.• Represented Tufts Health Plan on-site at health fairs for new client employer accounts.• Responsible for department-wide reporting on KPIs, short- and long-term trend identification, and providing data-backed business insights & recommendations as de facto business analyst.
