Provider Service Agent - JHP

Provider Services Agent

The Provider Services Agent plays a critical role in supporting Jefferson Health Plans' provider network by serving as a trusted resource and fostering positive provider relationships. This call center-based position acts as a liaison between providers and the organization, helping to ensure providers receive timely assistance, accurate information, and exceptional service experience. This role requires strong communication, problem-solving, and customer service skills, as well as the ability to navigate multiple systems and adapt to a fast-paced environment. Through effective issue resolution and provider support, the Provider Services Agent contributes to operational excellence, provider satisfaction, and the overall success of Jefferson Health Plans.

Job Duties

• Serve as a primary point of contact for providers, delivering accurate, professional, and timely support regarding eligibility, benefits, authorizations, claims status, network participation, and plan policies.
• Investigate and resolve provider inquiries by reviewing claims, researching issues, coordinating with internal departments, and facilitating appropriate escalations to ensure effective resolution
• Educate providers on Jefferson Health Plans processes, programs, and self-service tools, including Provider Portal capabilities and available resources
• Accurately document provider interactions and maintain compliance with departmental procedures, quality standards, and documentation requirements
• Efficiently manage inbound and outbound communications while adhering to established protocols for information security, call handling, and cross-functional collaboration
• Meet established performance, productivity, and quality standards while participating in ongoing training and professional development activities
• Contribute to a positive provider experience by supporting operational initiatives, maintaining current knowledge of plan guidelines, and performing other related duties as assigned

Minimum Qualifications

• High School Diploma/GED or 3 years of equivalent work experience.
• 2 years of inbound call center experience.
• Strong organizational, analytical, communication, and interpersonal skills with the ability to effectively manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office applications and the ability to efficiently navigate multiple systems, databases, and applications while maintaining a high level of accuracy and attention to detail.
• Demonstrated problem-solving and customer service skills, including the ability to quickly identify issues, provide effective solutions, and de-escalate challenging situations
• Dependable, adaptable, and goal-oriented professional with the ability to work independently and collaboratively while maintaining productivity in high-pressure environments.

Preferred Qualifications

• Claims experience preferred, including knowledge of HCPCS, ICD-10 coding, and government-sponsored healthcare programs such as Medicaid, CHIP, and Medicare.
• Experience using healthcare and customer relationship management systems (e.g., HRP, EPIC, Salesforce, HealthTrio, eCIS, CRM platforms) with the ability to work effectively both independently and within a team environment

Additional Qualifications Physical Demands Lift and carry 7 lbs., continuous sitting >67%, frequent keyboard use/repetitive motion, frequent fine motor activity/wrist position deviation.