Limited Term - Insurance/Healthcare Rep II
Hewlett Packard Enterprise – Enterprise Services (HPE ES) is a leading global technology services provider delivering out sourcing services and business solutions to clients around the world. HPE ES founded the information technology outsourcing industry nearly a half-century ago and today delivers one of the industry’s broadest portfolios of information technology, applications and business process outsourcing services available on the market today.
Job Description: The Insurance/Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider appeals and meets with providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs.
- Respond to questions regarding Member and Provider eligibility via phone.
- Assist callers in a fast paced Call Center environment and apply basic knowledge of Medical billing.
- Participates productively as a member of a team.
- Completes tasks beyond general support level.
- Accepts instruction and direction from leadership. Ability to manage tasks and assignments without detailed direction.
- Identifies, prioritizes and resolves some issues independently, and escalates more complex questions or issues appropriately.
- Complies with contract requirements, business unit rules and related and legal regulations.
Education and Experience:
- High School Diploma or equivalent; may hold 2 year post-high school Degree; may hold Bachelor’s degree.
- Typically, 1-2 years of working experience in related fields.
Knowledge and Skills:
- Prior Call Center experience is required.
- Ability to follow written policies and procedures.
- Ability to access and retrieve information using a PC and basic understanding of Microsoft Office products.
- Ability to follow procedural guidelines.’
- Ability to work on assignments with limited instructions from leadership.
- Good written and verbal communication skills, including professional telephone skills.
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