Credentialing Support Associate III

Guardian Life; Newport Beach (CA); Ibrido; USD 36.000 - 55.000; Tempo pieno

Descrizione del lavoro

Guardian Life seeks a Credentialing Support Associate III to maintain accurate provider records and support credentialing and recredentialing within regulatory and NCQA standards. You will coordinate outreach, resolve discrepancies, and ensure complete credentialing files in a fast-paced healthcare environment.

The role emphasizes attention to detail, data accuracy, and strong communication with providers and internal teams to support compliant network operations.

Competenze

• High school diploma or equivalent; Associate's or Bachelor's degree preferred.
• Experience supporting provider credentialing, healthcare operations, provider enrollment, or administrative processes.
• Experience maintaining and updating data within databases or business systems.
• Strong attention to detail and commitment to data accuracy.
• Excellent verbal and written communication skills.
• Ability to follow established processes and regulatory requirements.
• Strong organizational and time management skills.
• Ability to manage multiple priorities in a deadline-driven environment.
• Proficiency with Microsoft Office applications, including Excel and Outlook.

Mansioni

• Maintain accurate provider information by entering, updating, and auditing data within credentialing systems.
• Coordinate recredentialing activities, including distributing recredentialing communications and monitoring provider responses.
• Communicate with providers to obtain missing documentation, resolve discrepancies, and ensure complete credentialing files.
• Conduct primary source verification activities for initial credentialing and recredentialing applications in accordance with regulatory requirements and company standards.
• Track and follow up on outstanding credentialing requirements to support timely processing and compliance.
• Partner with internal stakeholders to ensure provider records are accurate, complete, and compliant with organizational policies.
• Support continuous improvement efforts that enhance credentialing processes and data quality.

Conoscenze

Attention to detail

Verbal and written communication

Regulatory compliance

Time management

Multitasking

Formazione

High school diploma or equivalent

Associate's or Bachelor's degree preferred

Strumenti

Microsoft Office (Excel, Outlook)

Descrizione del lavoro

Fully Remote

Work From Home - WA

Newport Beach - Regional Office

Full time

R000110479

RESPONSIBILITIES: Enters and upkeeps provider data in the credentialing database. Facilitates recredentilaling malings to network providers according to process guidelines. Monitors and communicates with providers to address any discrepancies or missing information, including regular follow up outreach attempts. Performs primary source verification of provider applications submitted for initial credentialing and re-credentialing according to regulatory requirements and company standards.

FAMILY: CREDENTIALING: Responsible for the credentialing and re-credentialing of applications for prospective and contracted vision, dental and hearing providers. Ensures all state and federal regulations are met, and that all activities are compliant with National Committee for Quality Assurance (NCQA) standards.

Position Summary

Are you detail-oriented and passionate about ensuring accuracy and compliance in healthcare provider data? Do you enjoy working in a fast-paced environment where organization, communication, and problem-solving are critical to success? Guardian is seeking a Credentialing Support Associate III to support the provider credentialing and recredentialing process by maintaining accurate provider records, coordinating provider outreach, and ensuring compliance with regulatory and organizational requirements. In this role, you will work closely with providers and internal stakeholders to validate information, resolve discrepancies, and support high-quality provider network operations.

A highly organized professional with exceptional attention to detail and a commitment to accuracy. You thrive in structured processes, enjoy managing multiple priorities, and can effectively communicate with providers to obtain critical information and resolve issues. You understand the importance of compliance and take pride in maintaining accurate records while delivering excellent customer service.

You Have

Required Qualifications

• High school diploma or equivalent; Associate's or Bachelor's degree preferred
• Experience supporting provider credentialing, healthcare operations, provider enrollment, or administrative processes
• Experience maintaining and updating data within databases or business systems
• Strong attention to detail and commitment to data accuracy
• Excellent verbal and written communication skills
• Ability to follow established processes and regulatory requirements
• Strong organizational and time management skills
• Ability to manage multiple priorities in a deadline-driven environment
• Proficiency with Microsoft Office applications, including Excel and Outlook

Preferred Qualifications

• Experience with provider credentialing and recredentialing processes
• Familiarity with NCQA, CMS, state, or other healthcare regulatory requirements
• Experience conducting primary source verification activities
• Experience working with credentialing software or provider management systems
• Knowledge of healthcare provider networks and credentialing standards

You Will

• Maintain accurate provider information by entering, updating, and auditing data within credentialing systems.
• Coordinate recredentialing activities, including distributing recredentialing communications and monitoring provider responses.
• Communicate with providers to obtain missing documentation, resolve discrepancies, and ensure complete credentialing files.
• Conduct primary source verification activities for initial credentialing and recredentialing applications in accordance with regulatory requirements and company standards.
• Track and follow up on outstanding credentialing requirements to support timely processing and compliance.
• Partner with internal stakeholders to ensure provider records are accurate, complete, and compliant with organizational policies.
• Support continuous improvement efforts that enhance credentialing processes and data quality.

Reporting Relationships

As our Credentialing Support Associate III , you will report to the Credentialing leadership team.

Location

The primary location for this position is Remote with regional office in Newport Beach, CA .

Salary Range

$36,410.00 - $54,612.50

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

Our Promise

At Guardian, you'll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Inspire Well-Being

As part of Guardian's Purpose - to inspire well-being - we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits . Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

Equal Employment Opportunity

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Accommodations

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [e-mail] . Please note: this resource is for accommodation requests only. For all other inquires related to your application and careers at Guardian, refer to the Guardian Careers site.

Visa Sponsorship

Guardian Life is not currently or in the foreseeable future sponsoring employment-based visas (e.g., such as an H-1B). In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship/support now or at any time in the future.

Notice Regarding Guardian's Use of Artificial Intelligence in Recruitment

As part of Guardian's job application process, Guardian may use artificial intelligence tools ("AI Tools") to automate the sorting and filtering of information provided by applicants as part of its preliminary screening. This preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on Guardian's jobs website (Careers at Guardian at https://www.guardianlife.com/careers ). At Guardian, we do not use AI Tools to substantially assist or replace human judgment or discretionary decision making in our hiring process. All hiring decisions will be made by Guardian colleagues.

Please be aware that if you apply for a specific position with Guardian, you will have the choice of opting out of Guardian's use of AI Tools during the job application process. If you would like to request an alternative process that does not utilize AI Tools or would like to request a reasonable accommodation, within ten business days of your position application, you must email your request to [e-mail] , making sure to provide your name and job requisition identification number. Guardian will retain your applicant materials and resume and all information therefrom in accordance with Guardian's document retention policy, a copy of which you may request via [e-mail] .

Additionally, at applicable times, Guardian will make public the most recent bias audit results for such AI tools, which may be found here https://assets.ctfassets.net/gau1nv66ynug/1M2AOzFsFCirlWeAmIh4MD/23463b78b6cdd8ebdce9410b98d7a080/Audit.pdf .

Current Guardian Colleagues

Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being - mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com .

Visa Sponsorship

Guardian Life is not currently or in the foreseeable future sponsoring employment-based visas (e.g., such as an H-1B). In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship/support now or at any time in the future.