Provider Services Representative

SFM Mutual Insurance Company; Minnesota; Hybrid; USD 56,000 - 78,000; Full time

Benefits offered by this job

Comprehensive benefits (medical/dental

Hybrid work environment

401(k) with company match

Student loan repayment assistance

Generous PTO and paid holidays

Life/ disability insurance

Job summary

SFM Mutual Insurance Company is seeking a Provider Service Representative to support the Insurance Operations Department in Minnesota. You will handle records requests for workers' compensation claims, ensure timely processing, and liaise with providers to resolve billing inquiries while maintaining data integrity.

The role emphasizes high service standards, collaboration with internal teams, and adherence to HIPAA and regulatory requirements within a semi-paperless environment.

Qualifications

• Associates degree, or equivalent work experience relevant to the role.
• Four or more years’ experience working in an insurance operations environment processing medical claims/bills, workers' compensation claims, commercial or property casualty insurance claims or related field.
• Demonstrated experience providing customer driven solutions, support, and/or service.
• Excellent customer service abilities and able to manage difficult situations effectively.
• Strong working knowledge handling workers' compensation, property/casualty, health insurance claims, or processing insurance policies is highly desirable.
• Exceptional communication/interpersonal skills and ability to interact within a diverse team environment and collaborate with other business partners.
• Excellent oral, written communication and presentation skills.
• Excellent MS Office software applications (Excel, Word, ) and familiarity with working within a paperless environment.
• Strong attention to detail with the ability to verify and cross check
• Strong organizational, time management and troubleshooting skills.
• Must be able to work on business premises as

Responsibilities

• Using proper authorization, you will request and obtain a variety of documents/records in connection with a workers' compensation claim or legal investigation under the direction of a claims or legal representative and does so in a timely manner ensuring that all time lines are met.
• Forward the records received to the correct file, documents receipt of the needed records and verifies the quality of the received information while ensuring the records are organized and presentable for the customer, and provide regular updates concerning the status of request.
• Reviews, authorizes, submits, and reconciles invoices for requested records using State specific regulations, internal policies and guidelines as well analyzing, troubleshooting and responding to inquiries related to duplicate payments and pursues active reconciliation to include recovery of funds as needed.
• Provides guidance concerning SFM's billing practices and acts as a resource for providers concerning bills submitted for payment while looking for efficiencies improving e-billing opportunities and troubleshooting areas of discrepancy concerning bills submitted for payment and created documentation as needed.
• Handles complex matters and deals with escalated situations and issues with limited supervision and may contribute to miscellaneous team tasks when needed and acts as a liaison with medical providers and other vendors, resolving billing inquiries and gathering additional information as necessary.
• Maintains the internal medical provider and legal database tables, making accurate updates when needed and handles W-9 tax forms when appropriate for the maintenance of the medical provider table as well as handling monthly and quarterly reports pertaining to the vendor and provider table and its information integrity.
• Follows State and Federal regulations, as well as comply with HIPPA requirements, internal policies and guidelines while requesting confidential information and records. Manages confidential information with discretion and good judgement in accordance with team and Company guidelines.
• Provides a high level of customer service for all business partners and customers while adhering to the Company’s service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality service to internal and external customers and all business partners.

Skills

Customer service

Communication

Problem solving

Education

Associate degree or equivalent

Tools

MS Office

Job description

Pay: $55,971.00 to $78,359.00

Ranked #8 Top Workplace - Midsize Employer, MN

About the Role

At SFM, our Provider Service Representatives work in a team driven environment in our Insurance Operations Department. That Department is the "hub of SFM". It is multi-functional, fast paced, and production oriented. This role has a variety of tasks which include requesting records, monitoring those requests and working with a multitude of provider/vendor relationships analyzing documentation for the retention and or retrieval of documents in accordance with established best practices and procedures. You will play a vital role in the management of workers' compensation claims and be part of SFM's goal of delivering unrivaled customer service seeking positive outcomes for employers and injured workers in connection with a workers' compensation claim. Our employees are encouraged to "do the right" thing and lead from within. If you thrive in an environment that gives you lots of variety, than this position may fit your professional goals.

What You will Do

• Using proper authorization, you will request and obtain a variety of documents/records in connection with a workers' compensation claim or legal investigation under the direction of a claims or legal representative and does so in a timely manner ensuring that all time lines are met. Using organizational skills, problem solving skills and initiative you will follow up on documents that are not received and communicate with internal customers providing updates on the status of requests and dig into files to find missing information.
• Forward the records received to the correct file, documents receipt of the needed records and verifies the quality of the received information while ensuring the records are organized and presentable for the customer, and provide regular updates concerning the status of request.
• Reviews, authorizes, submits, and reconciles invoices for requested records using State specific regulations, internal policies and guidelines as well analyzing, troubleshooting and responding to inquiries related to duplicate payments and pursues active reconciliation to include recovery of funds as needed.
• Provides guidance concerning SFM's billing practices and acts as a resource for providers concerning bills submitted for payment while looking for efficiencies improving e-billing opportunities and troubleshooting areas of discrepancy concerning bills submitted for payment and created documentation as needed.
• Handles complex matters and deals with escalated situations and issues with limited supervision and may contribute to miscellaneous team tasks when needed and acts as a liaison with medical providers and other vendors, resolving billing inquiries and gathering additional information as necessary.
• Maintains the internal medical provider and legal database tables, making accurate updates when needed and handles W-9 tax forms when appropriate for the maintenance of the medical provider table as well as handling monthly and quarterly reports pertaining to the vendor and provider table and its information integrity.
• Follows State and Federal regulations, as well as comply with HIPPA requirements, internal policies and guidelines while requesting confidential information and records. Manages confidential information with discretion and good judgement in accordance with team and Company guidelines.
• Provides a high level of customer service for all business partners and customers while adhering to the Company’s service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality service to internal and external customers and all business partners.

What We’ll Like About You

• Associates degree, or equivalent work experience relevant to the role.
• Four or more years’ experience working in an insurance operations environment processing medical claims/bills, workers' compensation claims, commercial or property casualty insurance claims or related field.
• Demonstrated experience providing customer driven solutions, support, and/or service.
• Excellent customer service abilities and able to manage difficult situations effectively.
• Strong working knowledge handling workers' compensation, property/casualty, health insurance claims, or processing insurance policies is highly desirable.
• Exceptional communication/interpersonal skills and ability to interact within a diverse team environment and collaborate with other business partners.
• Excellent oral, written communication and presentation skills.
• Excellent MS Office software applications (Excel, Word, ) and familiarity with working within a paperless environment.
• Strong attention to detail with the ability to verify and cross check
• Strong organizational, time management and troubleshooting skills.
• Must be able to work on business premises as

Why You’ll Love Working Here

We want your work life to feel balanced, rewarding, and supported. Here are just a few of the benefits SFM offers:

• Comprehensive medical, dental, and vision coverage (plus HSA/FSA options).
• Significant Cash Benefit if You Opt Out of Our Health Plan
• Flexible hybrid work environment.
• 401(k) with both Traditional and Roth options + company match.
• Contributions toward student loan repayment.
• Generous PTO, 9 paid holidays, and paid parental leave.
• Monthly home internet allowance.
• Free life insurance, short-term & long-term disability coverage.
• Incentive bonus opportunities.
• Discounts on gyms, fitness apps, and wellness programs.

Who We Are

SFM is the leading workers' compensation insurer in Minnesota, with a growing presence across the Midwest. We're proud to be recognized as aTop Workplace (#8 midsize employer in MN) thanks to our supportive culture, commitment to our employees, and focus on doing what's right. Learn more by clicking here .

The base pay posted is just one component of SFM's total compensation package. The salary range listed represents the full compensation range for this position. Job title and starting pay will be based on the selected candidate’s relevant knowledge, skills, abilities and/or experience, and education, if applicable as well as internal equity with other employees in the same job classification. #SFM

Work Environment and Physical Demands

Regular attendance is required. Work takes place in a semi paperless environment within an office setting, either on business premises or other remote location, using standard office equipment such as computers, phones, and copiers, which requires being stationary for extended periods of time. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions.

SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. SFM 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, status with regard to public assistance, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

SFM Companies, EEO/AA Employers.SFM is a participant of E-Verify.Applicants have rights under Federal Employment Laws.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.