Provider Technical Services Team Lead

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.

Responsibilities:

  • Actively participates as a key member of the team in a team lead role.
  • Completes complex tasks, defined processes and suggests creative solutions.
  • Multiple complex assignments are worked and are completed simultaneously with minimal input from leadership.
  • Identifies, prioritizes and resolves most questions and issues independently.
  • Interpret and provides recommends for all and contract requirements, business rules and related industry and legal regulations
  • Monitor 50 to 60 calls per month to insure that provider services call center procedures and quality standards are strictly adhered to
  • Team lead will be responsible for organizing training sessions for all agents under the supervision of call center supervisor
  • Assist supervisor with monthly evaluations as needed
  • Prepare monthly reports, update business trackers and handle escalations
  • Attend meetings and must report any adhoc issues to the supervisor on duty and the appropriate department
  • Must have excellent attendance and assist agents as needed

Education and Experience:

  • High School Diploma or equivalent; may hold 2 year post-high school Degree; may hold Bachelor’s degree.
  • Typically, 3-5 years of working experience in related fields

Knowledge and Skills:

  • Strong office experience and skills, possibly in a lead capacity. Strong healthcare related knowledge.
  • Intermediate to Senior level knowledge of operating systems, and of software skills.
  • Ability to develop and document procedures.
  • Ability to research and resolve inquiries.
  • Ability to read and interpret moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.
  • Ability work on multiple assignments/issues with limited instructions from leadership.
  • Self-motivated with strong time management and organizational skills.
  • Excellent written and verbal communication skills and customer service skills, including professional telephone skills.

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