Provider Customer Service Representative (Health Insurance)

Sutherland; San Antonio (TX); Remote; USD 19,000 - 25,000; Full time

Benefits offered by this job

Medical/dental/vision

Flexible vacation (post-training)

Company equipment

EAP/wellness with trainer

Employee discounts

80% internal promotion rate

Job summary

Sutherland is seeking a Provider Customer Service Representative (Health Insurance) to support a major health insurance company. The role involves handling inquiries on claims, eligibility, and authorizations from a home-based workstation, with training provided and a standard Mon–Fri schedule.

The position requires 1–2 years in a high-volume call center, strong communication, and basic health insurance knowledge. Benefits include medical/dental/vision and a supportive, remote work environment.

Qualifications

• High School Diploma (or equivalent) required.
• 1–2 years high-volume call center experience preferred.
• Strong typing and communication skills needed.

Responsibilities

• Handle status inquiries, denial rationales, appeals, medical records, research, and EOBs/EOPs.
• Verify eligibility, coverage, benefit grids, and credentialing.
• Explain self-service tools to providers and document interactions.
• Process claims, authorizations, and UM tasks as needed.

Skills

Typing 35–40 WPM

Strong communication

Active listening

Problem solving

Multitasking

Education

High School Diploma

Job description

Provider Customer Service Representative (Health Insurance)

• Full-time

Do you enjoy helping others, answering questions and resolving problems? Do you haveany experience in the healthcare/medical field or are you interestedin pursuing a career in the field? Are you looking for an opportunity to build a fulfilling career whileworking fromhome?

We're Sutherland, and we areseeking attentive, goal-oriented individuals to support the expanding needs of one of our largest health insurance company customers. In this role, you will be responsible for the following:

Claims & Authorizations: Handle status inquiries, denial rationales, appeals, medical records, research, and EOBs/EOPs.

Eligibility & Benefits: Verify provider participation, coverage, medical benefit grids, and credentialing.

Call Handling: Document details, drive resolutions, explain next steps, and educate on self-service tools (e.g., Availity).

Claims: Status, denial rationales, appeals, medical records, research/routing, EOB/EOP requests.

Authorizations & UM: Status, denial rationales, utilization management appeals, prior auth verification.

Eligibility & Benefits: Status, benefit grid interpretation, provider participation, credentialing.

Call Handling & Admin: Thorough call documentation, resolving next steps, educating providers on self-service tools (Availity), and back-to-back call management.

Pay & Schedule: $16/hour, paid training, Mon–Fri (8 AM–5 PM EST).

Perks: Medical/dental/vision, flexible vacation (post-training), company equipment, EAP/wellness with a dedicated trainer, employee discounts, and 80% internal promotion rate.

Requirements

Education & Experience: High School Diploma (or equivalent); 1–2 years high-volume call center experience.

Skills: 35–40 WPM typing, strong written/verbal communication, active listening, problem-solving, and multitasking.

Workplace & Tech: Dedicated quiet workspace, strict schedule adherence, and internet speeds of at least 10 Mbps download / 2 Mbps upload.

Eligibility: Must be a US resident authorized to work in the US.

Preferred Qualifications

1–2 years in a medical office, healthcare insurance, billing/coding, or back-end processing.

This role is open to those eligible to work in the USA.

EEOC and Veteran Documentation
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.