Provider Customer Service Representative

Remote, USA Full-time Posted 2025-07-25

Description:
? Answers questions and resolves issues based on phone calls/letters from providers.
? Provide excellent customer services for high volume inbound provider calls.
? Extensive claims research on multiple platforms.
? Uses customer service threshold framework to make financial decisions.
? Processes claim referrals, new claim handoffs, nurse reviews, and provider complaints.
? Educates & assists providers on our self-service options.
? Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility.
? Performs review of member and provider claim history.

Requirements: ? Familiarity with Microsoft Office products ? Excellent computer skills using multiple screens and systems ? Experience in highly transactional call center environment ? Excellent customer service and critical thinking ? Secure, private home office location ? High speed internet access (100 mbps or higher)

Benefits:
? Full range of medical, dental, and vision benefits
? 401(k) retirement savings plan
? Employee Stock Purchase Plan
? Fully-paid term life insurance
? Short-term and long-term disability benefits
? Well-being programs
? Education assistance
? Free development courses
? CVS store discount
? Paid Time Off (PTO)
? Paid holidays

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Provider Customer Service Representative

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