Provider Experience Center Representative

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Respond to incoming calls from providers and their staff.

• Investigate, document, and address provider inquiries and escalated calls.

• Manage a high volume of inbound and outbound calls related to health insurance providers.

• Deliver precise information concerning claims, benefits, member out-of-pocket expenses, and payments, either by phone or in writing.

• Verify and process claim payments in accordance with plan guidelines.

• Analyze issues and perform necessary follow-up with physicians, facility staff, professional staff, and physician office personnel.

• Identify and resolve managed care issues related to claims, contract interpretation, utilization management, eligibility, and overall operations.

• Interpret contract language and address contract-related issues.

• Support internal departments with provider appeals.

• Educate physicians, office staff, hospitals, and insurance plan administration teams.

• Participate in assigned special projects.

• Adhere to department standards for quality, quantity, timeliness, and compliance.

• Prioritize tasks and complete work with minimal supervision.

⛳️ Requirements

• High school diploma/GED or equivalent work knowledge.

• Three to four years of relevant work experience in healthcare services, particularly in a high-volume service center or managed care setting.

• Capability to multitask between inbound calls, database or resource-tool searches, and professional customer service.

• Strong verbal and written communication abilities.

• Ability to meet deadlines in a multi-tasking environment.

• Exceptional organizational skills.

• Operational proficiency in word processing, spreadsheets, data entry, fax machines, and other computer-related skills.

• Ability to learn and utilize the company's provider information systems.

• Basic understanding of organizational expectations.

• Skill in establishing daily work priorities and working efficiently.

• Preferred: Associate's degree or equivalent knowledge in business/healthcare.

• Preferred: One to two years of experience in medical claims adjudication, contract interpretation, billing and coding, and medical terminology.

• Additional relevant education and/or experience is preferred.

• Must be a resident of the state of Arizona.

🏝️ Benefits

• Opportunity for remote work.

• Please note that roles with Banner Staffing Services do not provide medical benefits or accrue paid time off.

• Assignment-based position without a guaranteed number of hours.