Provider Support Specialist, Healthcare Claims & Provider Relations
Overview
You will act as the primary point of contact for healthcare providers and their staff, resolving complex claims, benefits, and administrative issues. Pride Health is scaling its Provider Services team, and you will play a key role in that growth. You will collaborate with cross-functional teams like Claims, Product, and Network to drive timely resolutions and influence process improvements. This hybrid role, based in Salt Lake City or Lehi, requires onboarding at least two weekdays per week, with the flexibility to work remotely the rest of the time. You will directly shape the provider experience by identifying trends, escalating systemic problems, and contributing to internal tool and workflow development.
What You'll Do10
- 1Serve as the primary liaison between healthcare providers and the company, ensuring timely and accurate support via phone and provider portal messaging.
- 2Investigate and resolve complex provider inquiries related to claims submission, status, adjudication, benefit interpretation, member cost-sharing, prior authorizations, and appeals.
- 3Verify patient eligibility and coverage details, communicating accumulator balances and benefit information clearly to provider offices.
- 4Document all interactions thoroughly within internal systems, maintaining high-quality records for audit and reference.
- 5Drive cross-functional collaboration with Claims, Product, and Network teams to resolve issues that require escalation.
- 6Identify trends in provider issues and escalate systemic problems for root cause analysis and process improvement.
- 7Contribute to the development of internal tools, workflows, and training materials that enhance efficiency and provider satisfaction.
- 8Educate providers on self-service tools and best practices, reducing friction and improving their experience with the company's systems.
- 9Meet or exceed established SLAs for response and resolution times, ensuring providers receive clear and accurate outcomes.
- 10Provide direct feedback to the operations team on recurring issues, influencing continuous improvement initiatives.
Requirements13
- 12+ years of experience in healthcare operations, provider support, or medical claims.
- 2Strong understanding of claims adjudication, eligibility, and prior authorization processes.
- 3Excellent written and verbal communication skills, with the ability to explain complex information to providers and internal stakeholders.
- 4Highly organized with strong attention to detail and documentation accuracy.
- 5Ability to manage multiple priorities in a fast-paced, high-volume environment.
- 6Experience working independently in a remote or hybrid setting.
- 7Familiarity with HIPAA and patient confidentiality requirements.
- 8Proven problem-solving skills and the ability to navigate ambiguity.
- 9Preferred: Experience with provider-facing or B2B support roles in healthcare.
- 10Preferred: Familiarity with tools such as Availity, Zelis, or similar clearinghouse platforms.
- 11Preferred: Experience with contact center systems and case management tools (e.g., Assist).
- 12Preferred: Understanding of common claim denial reasons and healthcare payment cycles.
- 13Preferred: Bachelor's degree in Healthcare Administration or a related field (or equivalent experience).
Salary Insight
$48k per year
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