Provider Relations Associate Analyst

Pyramid Consulting, Inc; United States; On-site; USD 25,485 - 26,863; Full time

Benefits offered by this job

Health Insurance (Medical, Dental, Vision)

401(k) Plan

Paid Sick Leave

Job summary

An established industry player is seeking a motivated Provider Relations Associate Analyst for a remote contract position. This role involves assisting members and providers with claims processing, ensuring exceptional customer service, and maintaining a professional demeanor in a virtual environment. The ideal candidate will possess strong interpersonal communication skills and a bachelor's degree, with the ability to navigate various claim systems. Join a leading health insurance organization that values your contributions and offers a supportive team atmosphere. This opportunity promises growth and the chance to make a real impact in the healthcare sector.

Qualifications

• Strong customer service skills with experience in healthcare insurance.
• Ability to work in a virtual team environment and manage multiple tasks.

Responsibilities

• Answer inbound claim calls and assist members or providers.
• Educate on billing protocols and verify claim statuses.
• Independently problem-solve for accurate information and service.

Skills

Provider Relations

Claims Processing

Customer Service

Interpersonal Communication

Technical Capabilities

Problem Solving

Typing Skills

Education

Bachelor's Degree

Job description

Get AI-powered advice on this job and more exclusive features.

Pyramid Consulting, Inc provided pay range

This range is provided by Pyramid Consulting, Inc. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$18.50/hr - $19.50/hr

Immediate need for a talented Provider Relations Associate Analyst. This is a 06+ Months Contract opportunity with long-term potential and is located in U.S.(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-63394

Pay Range: $18.50 - $19.50/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• The primary responsibility of this role is to answer inbound claim calls from members or providers, as well as contracting and Provider Relations related calls from providers.
• The work environment is structured, and the majority of the day will be spent answering these calls from a queue.
• Occasional outbound calls may be necessary for issues requiring follow-up.
• Within a call a Claims & PR Advocate may:
• Assist a member or provider with understanding how a claim has processed.
• Verify claim status for a member or provider.
• Educate a member or provider on billing protocols.
• Write or correct authorizations to ensure claims are paid correctly.
• Send claims for adjustment/reprocessing.
• Request duplicate EOBs for a member or provider.
• Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check.
• Provide follow-up on issues by making outbound calls when necessary.
• Send resources to members and providers via email.
• Submit a complaint on the member or provider's behalf.
• Send handoff requests to matrix partners for escalated or complex issues.
• Assist providers with contract related inquiries and demographic updates.
• Independently problem-solve to ensure accurate information is given, exceptional customer service, and first call resolution is achieved.

Key Requirements and Technology Experience:

• Skills: Provider Relations, Claims or claim processing, Member service, member or provider, CSR (Healthcare Insurance), bachelor's degree.
• Customer Service experience
• Able to excel and/or prior successful experience in a virtual team environment.
• Ability to maintain a professional and positive image to members, providers, facilities, billing offices, etc.
• Candidate must possess superb interpersonal communication skills.
• Effective listening and organizational skills, with the ability to manage multiple tasks.
• Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several claim systems and applications.
• Independent problem-solving skills.
• Ability to type effectively and have strong PC skills.
• A bachelor's degree is required.

Our client is a leading Health insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.

Seniority level

Not Applicable

Employment type

Contract

Job function

Analyst

Industries

Hospitals and Health Care and Insurance