Provider Customer Service Representative (Health Insurance)
Core
Handle provider inquiries regarding insurance claims, authorizations, eligibility, and benefits for a large health insurance company.
Role type
Customer Service Representative (Health Insurance)
Builds
Provider support services for a health insurance client
Domain
Health Insurance / Customer Support
Deliverable
client delivery
Required skills
High-volume call center experience, 35–40 WPM typing, active listening, problem-solving, multitasking
Preferred skills
Medical office experience, healthcare insurance knowledge, billing/coding experience, back-end processing experience
Technologies
Availity
Responsibilities
Handle claims status, denial rationales, appeals, and medical records; Verify authorizations and utilization management appeals; Interpret benefit grids and verify provider participation; Document calls and educate providers on self-service tools
