Provider Services Representative


Job Description

This position is responsible for answering inbound calls and communicating appropriate information concerning telephonic inquiries for all business segments. The role is responsible for documenting the nature of the inquiry and specific resolution within various operating systems. In addition, the role is responsible for placing outreach calls to providers to support the Network organization and is responsible for interacting with providers via Magellan?s provider Chat Application. The overall expectation of this role is to utilize analytical, problem solving abilities while providing outstanding customer support to internal/external customers and to appropriately resolve inquiries during their initial interaction with Magellan. Role also provides peer support and mentoring with systems and polices and procedures.
  • Performs daily activities in accordance with Magellan's standards for call center operations, including First Call Resolution, and Qfiniti Evaluation Scorecard.
  • Demonstrates expertise of job functions by minimizing call handle times, by actively listening and probing providers during the initial call to determine the purpose of the call.
  • Collects and documents all details of provider interaction (inquiry, comments and information) into the Magellan operating systems.
  • Professionally educates providers on Magellan's policies and procedures and how to effectively interact with Magellan to optimize the provider's experience. Respond to the provider's inquiry in the most efficient manner.
  • Demonstrates working knowledge of all information and updates pertaining to new and or changes to existing: products, procedures, customers, etc., across all business lines. Research and provide information regarding provider network status, web access password, credentialing/re-credentialing documents and procedures, contracting process criteria, clinical/authorization procedures, claims/reimbursement procedures, as well as define and direct resolution for related data entry issues.
  • Interacts with other functional departments (e.g., clinical, claims, etc.) , as needed to develop optimal resolution for Provider and Magellan.
  • Based on interactions with providers, recommend changes to policies, procedures or business practices that create provider dissatisfaction or enhance the Provider's experience with Magellan.
  • Daily requirements may include filing, faxing, copying, coding of documents, support to Field Network in provider recruitment and training activities, reviewing error reports, and providing back-up to other functional teams.

General Job Information


Provider Services Representative



Job Family

Customer Service Group


United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Customer Service, Healthcare


GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


  • Must demonstrate a high level of motivation and willingness to cross-train in all aspects of the department.
  • Must be a proficient typist (at least 30 WPM) with the ability to maneuver through various computer platforms/screens while verifying a variety of information simultaneously.
  • Ability to multi-task while staying organized.

Customer Service experience in a Health Care environment.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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