Provider Support Specialist

Russell Tobin; Lehi (UT); Hybrid; USD 30,000 - 32,000; Full time

Benefits offered by this job

Healthcare coverage

401(k) retirement savings

Life & disability insurance

Employee discounts

Employee assistance program

Job summary

Russell Tobin is seeking a healthcare operations specialist in Lehi, Utah, operating in a hybrid role with onsite expectations at least two weekdays per week. The position offers a pay rate of $22–$23.15 per hour and requires prior provider support and claims knowledge.

You will liaise between healthcare providers and our company, ensuring timely, accurate responses, and maintaining strong provider relationships while supporting claims, eligibility, prior authorizations, and coordination of

Qualifications

• 2+ years in healthcare operations or provider support.
• Strong understanding of claims adjudication, eligibility, and prior authorization processes.
• Excellent written and verbal communication skills; ability to explain complex information clearly.
• Highly organized with strong attention to detail and documentation accuracy.
• Experience working independently in a remote or hybrid setting.
• Familiarity with HIPAA and patient confidentiality requirements.

Responsibilities

• Serve as a primary liaison between healthcare providers and the company, delivering timely, accurate, and professional support via phone and provider portal messaging.
• Build and maintain strong relationships with provider offices, fostering trust and long-term partnership.
• Investigate and resolve complex provider inquiries related to claims submission, status, and adjudication.
• Explain benefits and plan interpretation; address member cost-sharing and billing questions.
• Assist with prior authorizations and coordination of benefits; manage appeals and potential overpayments.

Skills

Healthcare operations

Provider support

Claims knowledge

HIPAA compliance

Remote/hybrid work experience

Education

Bachelor’s degree in healthcare administration or related field

Tools

Availity

Zelis

Assist

Job description

Pay Rate: $22-23.15/hour

This is a hybrid role based out of our Lehi office, with an expectation of being onsite at least two weekdays per week.

Job Description

• Serve as a primary liaison between healthcare providers and the company, delivering timely, accurate, and professional support via phone and provider portal messaging
• Build and maintain strong relationships with provider offices, fostering trust and long-term partnership
• Investigate and resolve complex provider inquiries related to:
• Claims submission, status, and adjudication
• Benefit and plan interpretation
• Member cost-sharing and billing questions
• Prior authorizations and coordination of benefits
• Appeals and overpayment recoupment
• Verify and communicate patient eligibility, coverage details, and accumulator balances
• Document all interactions thoroughly and accurately within internal systems
• Collaborate cross-functionally (Claims, Product, Network, etc.) to drive timely and effective issue resolution
• Identify trends in provider issues and escalate systemic problems for root cause analysis and resolution
• Contribute to the development and refinement of internal tools, workflows, and training materials
• Educate providers on self-service tools and best practices to improve efficiency and reduce friction
• Meet or exceed established Service Level Agreements (SLAs) for response and resolution times

What Success Looks Like

• Providers receive clear, accurate, and timely resolutions with minimal follow-up
• High-quality documentation and strong attention to detail across all interactions
• Demonstrated ability to independently resolve complex and ambiguous issues
• Consistent identification of trends and proactive contributions to process improvements
• Positive feedback from providers and internal stakeholders

Basic Qualifications

• 2+ years of experience in healthcare operations, provider support, or medical claims
• Strong understanding of claims adjudication, eligibility, and prior authorization processes
• Excellent written and verbal communication skills, with the ability to explain complex information clearly
• Highly organized with strong attention to detail and documentation accuracy
• Ability to manage multiple priorities in a fast-paced, high-volume environment
• Experience working independently in a remote or hybrid setting
• Familiarity with HIPAA and patient confidentiality requirements
• Proven problem-solving skills and ability to navigate ambiguity

Preferred Qualifications

• Experience in provider-facing or B2B support roles within healthcare
• Familiarity with tools such as Availity, Zelis, or similar clearinghouse platforms
• Experience with contact center systems and case management tools (e.g., Assist)
• Understanding of common claim denial reasons and healthcare payment cycles
• Bachelor’s degree in healthcare administration or a related field (or equivalent experience)

Tools & Systems

• Experience with or ability to quickly learn:
• Provider portals and clearinghouses (e.g., Availity, Zelis)
• CRM or case management systems (e.g., Assist)
• Internal knowledge bases and documentation tools

Benefits Info

Russell Tobin offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.

We collect personal information from applicants during the recruiting, pre-offer, and offer process.

During the recruiting, pre-offer process and offer process, we may collect the following categories of personal information:

• Identifiers, such as name, address, and email address.
• Professional and Employment-Related Information, such as resume, work history, education, and qualifications.
• Information Voluntarily Provided by You in connection with the recruiting and pre-offer process.
• Sensitive Personal Information, where legally permitted and necessary, such as Social Security number and date of birth.

Personal information is collected and used for the following business purposes: evaluating qualifications and eligibility for employment; communication regarding the recruitment and application process; verifying eligibility for employment; and complying with applicable legal, regulatory, and contractual obligations.

Personal information is collected and used only as necessary, and we are committed to data minimization, privacy, and providing equal employment opportunities. We are an international organization, and personal information may be accessed or processed by authorized personnel or service providers located outside the United States, subject to appropriate safeguards. We restrict use and access to personal information to authorized personnel and service providers with confidentiality and data security obligations. We maintain administrative, technical, and physical safeguards designed to protect personal information from unauthorized access, use, or disclosure.

For information about our privacy practices, please review our Privacy Policy at:

https://prideglobal.com/privacy-policy

If you do not consent to the collection of such personal information, please advise us immediately in writing at [e-mail]