Provider Relations Representative I

Cotiviti; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

Cotiviti, a leader in healthcare data analytics, is hiring for an entry-level role focused on claims processing. This position involves confirming receipt of claims, responding to inquiries, and analyzing documentation. Candidates are required to have a high school diploma and 2+ years of relevant experience. The role is primarily remote, requiring strong communication and organizational skills, providing essential support to improve healthcare outcomes.

Benefits

Competitive benefits package including medical, dental, and vision insurance

401(k) savings plans

Paid family leave

Paid Time Off (17-27 days per year)

9 paid holidays per year

Qualifications

• 2+ years’ experience in medical terminology and claims processing.
• Ability to work remotely in a dedicated workspace with high-speed internet.

Responsibilities

• Initiates phone calls to confirm receipt of mailings and requests action.
• Reviews and analyzes documentation and claim data.

Skills

Attention to detail

Multi-tasking

Communication

Organizational skills

Education

High school diploma or GED

Tools

Microsoft Word

Job description

Overview

Cotiviti, Inc. drives better healthcare outcomes through data analytics. This means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality.

Learn more at www.Cotiviti.com.

Responsibilities

• Initiates phone calls to customers, (providers/pharmacies/patients/carriers etc.) to confirm receipt of mailings, and to request action.
• Provides timely response and resolution for all provider initiated inquires (phone calls, emails or faxes).
• Reviews and analyzes documentation and claim data to determine validity and proper action.
• Updates accounts receivable system with denial and group information.
• Assists with high priority special projects.
• Performs other functions as assigned.

Qualifications

• High school diploma, GED, or equivalent work experience.

• 2+ years’ experience as an examiner/processor with exposure to medical terminology and claim processing experience in Commercial Insurance or Government Programs required o 2+ years previous experience in a claims customer service environment OR o 2+ years of answering inbound calls regarding claims processing.

• Ability to work proficiently with Microsoft Word.
• Ability to multi-task and prioritize.
• Ability to be careful and thorough about detail.
• Ability to organize well.
• Primarily sedentary work remotely.
• Ability to communicate and exchange information.
• Ability to comprehend and interpret documents and data.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions are expected.

Base compensation ranges from $17.50 to $19.50 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 06/16/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 06/23/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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