Provider Customer Service Representative (Health Insurance)

About the role

Do you enjoy helping others, answering questions and resolving problems? Do you have any experience in the healthcare/medical field or are you interested in pursuing a career in the field? Are you looking for an opportunity to build a fulfilling career while working from home? Join Us! We're Sutherland, and we are seeking attentive, goal‑oriented individuals to support the expanding needs of one of our largest health insurance company customers.

Responsibilities

• Handle status inquiries, denial rationales, appeals, medical records, research, and EOBs/EOPs.
• Verify provider participation, coverage, medical benefit grids, and credentialing.
• Document call details, drive resolutions, explain next steps, and educate on self‑service tools (e.g., Availity).
• Process claims: status, denial rationales, appeals, medical records, research/routing, EOB/EOP requests.
• Manage authorizations/utilization management: status, denial rationales, utilization management appeals, prior auth verification.
• Interpret eligibility & benefits: status, benefit grid interpretation, provider participation, credentialing.
• Perform call handling & admin: thorough call documentation, resolving next steps, educating providers on self‑service tools (Availity), back‑to‑back call management.

Requirements

• High School Diploma (or equivalent)
• 1–2 years high‑volume call center experience
• Dedicated quiet workspace
• Strict schedule adherence
• Internet speeds of at least 10 Mbps download / 2 Mbps upload
• Must be a US resident authorized to work in the US

Qualifications

• 1–2 years in a medical office, healthcare insurance, billing/coding, or back‑end processing (preferred)

Skills

• 35–40 WPM typing
• Strong written/verbal communication
• Active listening
• Problem‑solving
• Multitasking

Benefits

• Medical/dental/vision coverage
• Flexible vacation (post‑training)
• Company equipment
• EAP/wellness with a dedicated trainer
• Employee discounts
• 80% internal promotion rate

Pay

$16/hour, paid training

Schedule

Mon–Fri (8 AM–5 PM EST)