ACCOUNT RESOLUTION SPECIALIST

Job Title

/ ACCOUNT RESOLUTION SPECIALIST
AMJ201
Primary Function /
Core Job Responsibilities / Claims and billing expert capable of handling escalated issues, approving exceptions and/or writing responses on behalf of the carrier and HPS management team. Responsibilities include:
  • Handles one or more business units;
  • Handle escalated calls for one or more business units;
  • Assists with training;
  • Review and sign-off on all exceptions for one or more business units;
  • Respond to written inquiries, grievances and/or appeals as needed;
  • Work closely with management and the Voice of the Customer Unit to define problems and facilitate Process Improvement.
  • Supports the objectives of the team, department and corporation.
  • Takes on special projects as requested;
  • Will be scheduled off the phones as needed;
  • Maintains schedule adherence of 97%

Minimum Education & Experience /
  • High school diploma.
  • 2-5 years experience serving customers in same or similar environment
  • High degree of technical proficiency ---Subject Matter Expert
  • Training and experience preferred.

Expertise /
  • Symptoms and facts are vague or ambiguous and may not be related to underlying problems.
  • A particular problem may be a mixture of several problems in unrelated areas. Assumptions must be made to fill in gaps.
  • Considerable judgment is required in organizing and planning tasks, and selecting proper methods where established methods provide only general guidance.
  • Decisions involving modifying or adapting existing methods to unique situations.
  • Fundamental principles must be applied to complex tasks, requiring a high degree of creativity and ingenuity.

Accountability & Supervision /
  • May be accountable for work of others.
  • Minimal supervision required.
  • Tasks in direct support of the department's primary activities for which the incumbent has the direct responsibility for recommendations that will result in action with minimal review.
  • The impact may have significant dollar implications with a subtle loss of customer or other key external agencies confidence in HPS before the problem is identified.

Job Knowledge /
  • Basic general knowledge plus considerable administrative or creative knowledge of other functions or operations in order to develop new approaches to issues or problems.
  • Usually achieved with experience through multiple business cycles in various assignments, generally 3-5 years.
  • Effective job performance requires extensive experience.
  • In-depth knowledge of all departmental activities, reference materials, workflow, quality control measures and productivity standards

Physical Work Environment /
  • Normal degree of physical effort in typical office environment with comfortable, constant temperatures and absence of objectionable elements.
  • May be subject to interruptions.
  • Minimal physical exertion.
  • Required to work computer.

Computer Skills /
  • Strong computer knowledge.
  • Familiar with Microsoft Office.
  • 10-key operation by touch.

Competencies

Strategic / Organizational (Believe in HPHI)
Corporate Focus
(Believe in our strong foundation) /
  • Performs day-to day job responsibilities in ways that support the business focus of HPHI.
  • Understands and carries out responsibilities in line with assigned goals.
  • Understands issues and events that impact the business and the environment in which HPHI operates.
  • Responds aggressively to customer, client or business partner requirements.
  • Aligns work with department strategy.
  • Understands and carries out responsibilities in line with overall project goals.
  • Demonstrates awareness of changes in industry, competitors and company.
  • Committed to working with business partners to resolve problems.
  • Discerns information critical to client success.

Customer Focus
(Believe in Customers) /
  • Demonstrates awareness that customers are the reason for HPHI existence.
  • Every customer is an important customer. Understand customer needs, both internal and external, and looks for opportunities to provide the highest quality service.

Risk Management (Believe in Achievement) /
  • Recognizes risks relative to procedures and takes appropriate action.
  • Identifies and quantifies risks relative to an overall project.
  • Capitalizes on opportunities that contain an acceptable level of risk.

Visionary Strategy (Believe in Innovation) /
  • Demonstrates awareness of changes in industry, competitors and company.
  • Contributes to the development of tomorrow’s business strategy for the department.

Financial Focus

(Believe in Making a Difference) /
  • Responsible for personal and department budgetary savings.
  • Understands the financial dynamics of the business and how personal actions and decisions translate to the bottom line.
  • Consistently chooses and applies cost-effective course of action.
  • Reviews and reconciles all program billing and invoices and arranges for payments from appropriate cost centers.

Technological Focus (Believe in challenging the status quo) /
  • Identifies and implements processes and procedures to add value to the business of HPHI, a company considered a leader in technology.
  • Demonstrate functional excellence in the formulation, application and execution of technological strategies.
  • Displays the expertise and proficiency required to apply existing technology and develop new technology.

Quality Focus

(Believe in doing the right things right) /
  • Maintains appropriate documentation so that information is traceable and processes are transferable.
  • Recommends modification to work processes and procedures to maintain quality for the functional area.
  • Recommends appropriate metrics to measure process towards meeting quality standards for department.

Metric Focus
(Believe actions speak louder than words) /
  • Builds methods for measuring effectiveness of processes to meet business objectives.
  • Uses results to make decisions.

Professional
(Believe in My Work)
Analysis
(Believe in creating unlimited opportunity) /
  • Analyzes, reviews, and alters program to increase operating efficiency or adapt to new requirements.
  • Applies analytical techniques to research problems, integrate data identifies critical process variables. and synthesize results,
  • Evaluates the quality of the data and offer recommendations based on results.
  • Identifies and investigates the more complex problems and discrepancies requiring considerable research.

Creativity
(Believe in developing creative solutions) /
  • Challenges the status quo in thought and action, inspires creative thinking in others.
  • Demonstrates openness to change and aligns with innovative organizational needs and realities.
  • Develops pioneering responses to situations.
  • Produces through imaginative skill.

Planning
(Believe in hard work) /
  • Establishes and meets project goals and implementation plans
  • Makes plans to accomplish individual or team goals to specification (cost, quality, time).
  • Sets timeline.
  • Meets established attendance and punctuality guidelines.

Implementing
(Believe in making things happen) /
  • Implements project plans comprehending resource, budget, facility, and regulatory requirements to meet project goals.

Problem Solving

(Believe in our ability) /
  • Diverse problems that require interpretation of administrative and/or technical issues.
  • Work frequently requires original solutions
  • Complex problems require considerable research

Individual (Believe in Myself)

Communication (Believe a positive attitude is contagious)

/
  • High level of oral or written communication skills.
  • Persuasion and direction skills required to convert thinking of others where gathering acceptance is difficult but important to job performance.
  • Creates communication tailored to the needs of the receiver.
  • Exchanges information, both oral and written, with appropriate frequency and within a time frame to maximize its utility and promote cross-functional collaboration.
.

Interpersonal Relations (Believe all work is teamwork)

/
  • May use conflict to achieve improved outcomes; diverts tension away from individuals and towards work results and works out acceptable agreements that promote synergy.
  • Initiates and cultivates open, honest and beneficial relationships with colleagues and customers by establishing rapport, developing an understanding of others needs, promoting common goals and following through on commitments.
  • Ability to work independently.
  • Sufficient interpersonal skills to effectively motivate team

Teamwork (Believe in the power of teamwork)

/
  • Formulates and creates teams.
  • Excellent motivational skills.
  • Leads team activities.
  • Works toward continuous improvement and achieving or exceeding: team quality goals, team speed goals, and team productivity goals.

Development (Believe in motivation from within)

/
  • Translates changes in business goals and objectives into the skills, knowledge and experience needed for future work.

Leadership Activities (Believe and trust in people)

/
  • Trains others on the theoretical and practical basics of techniques and processes.
  • Participates in project planning and process updates.
  • Confronts issues in a constructive manner and at an appropriate organizational level.

Positive Attitude (Believe in loving what you do and having fun doing it)

/
  • The success of HPH depends on the attitude of every associate.
  • Highly motivated . Has passion for work.
  • Displays emotional and professional strength and maturity.
  • Demonstrates flexibility and resilience when faced with multiple demands, shifting priorities, ambiguity and rapid change.

Integrity (Believe in trust)

/
  • Approaches all business decisions and actions guided by sound personal and professional beliefs.
  • High level of credibility.
  • Earns trust by dealing honestly and following through on commitments.

11/5/20187:57 AM Account Resolution Specialist Rev. 1