Provider Services Specialist – Claims & Records

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

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.