Provider Inquiry Associate II

UST; Taguig; On-site; PHP 600,000 - 800,000; Full time

Job summary

UST in Taguig, Philippines, seeks a Provider Inquiry Specialist to review, investigate, and resolve provider inquiries related to claims, eligibility, benefits, authorizations, and payment details.

The role requires strong analytical skills and clear written communication to ensure timely provider responses while meeting SLA and quality standards. You will work with PEAR/OneHub and payer systems handling high-volume inquiries.

Qualifications

• Experience with US healthcare claims and provider support workflows.
• Strong analytical and problem-solving abilities.
• Excellent written communication for provider-facing explanations.
• Ability to handle high-volume, repetitive tasks accurately.

Responsibilities

• Review and investigate provider inquiries received through ticketing or portal-based systems.
• Analyze inquiries related to claim status and payment, eligibility and benefits, authorization status, denials and adjustments.
• Provide clear, accurate, and business-friendly responses to providers with explanations.
• Research claim details using payer systems and supporting tools to identify the correct resolution path.
• Route inquiries to appropriate internal queues when corrections or further investigation are needed.
• Document all actions in the case management system.
• Ensure SLA, TAT, and quality benchmarks for Provider Inquiry processes.
• Support backlog and aging clearance by prioritizing work based on turnaround requirements.
• Adhere to HIPAA guidelines and organizational compliance standards.

Skills

HIPAA

Claims Management

Process Improvement

Lean Six Sigma

Tools

PEAR Portal

OneHub

Pulse

Claims processing systems

Aerial/CFI/Burgess/HealthRule

Job description

Role Description

The Provider Inquiry Specialist is responsible for reviewing, investigating, and resolving inquiries raised by healthcare providers related to claims, eligibility, benefits, authorizations, and payment details. The role requires strong analytical skills, attention to detail, and clear written communication to ensure accurate and timely provider responses while meeting SLA and quality standards.

Key Responsibilities

• Review and investigate provider inquiries received through ticketing or portal-based systems (e.g., PEAR / OneHub).
• Analyze inquiries related to:
  • Claim status and payment
  • Eligibility and benefits
  • Authorization status
  • Denials and adjustments
• Provide clear, accurate, and business-friendly responses to providers with appropriate explanations.
• Research claim details using payer systems and supporting tools to identify the correct resolution path.
• Route inquiries to the appropriate internal queues or teams when corrections, adjustments, or further investigation are required.
• Document all actions and responses accurately in the case management or tracking system.
• Ensure compliance with SLA, TAT, and quality benchmarks for Provider Inquiry processes.
• Support backlog and aging clearance by prioritizing work based on turnaround requirements.
• Participate in quality feedback sessions, calibrations, and cross-audits to reduce repeat errors.
• Adhere to HIPAA guidelines and organizational compliance standards at all times.

Tools & Systems (Exposure Preferred)

• PEAR Portal / PPM
• OneHub / Pulse or similar ticketing systems
• Claims processing systems (payer side)
• Aerial / CFI / Burgess / HealthRule (or equivalent payer tools)

Required Skills & Competencies

• Strong understanding of US Healthcare claims and provider support workflows
• Good analytical and problem-solving skills
• Strong written communication skills (provider-friendly and clear explanations)
• Ability to handle high-volume, repetitive tasks with accuracy
• Attention to detail and documentation discipline
• Ability to work in a fast-changing environment with shifting priorities

Successful candidates will be asked to provide NBI, Previous Employment documents among others

Skills

HIPAA, Claims Management, Process Improvement, Lean Six Sigma