Provider Service Specialist

This position is temporary/seasonal through April 2027 and is a remote opportunity with a schedule of M-F, 8am-4:30pm EST. Medicare Advantage, managed care, health insurance, customer service, and call center experience are helpful.

About the Role

In accordance with the Mission and Guiding Behaviors, the Provider Service Specialist responds in a timely and accurate manner to provider inquiries made by phone, in person, and in writing regarding Plan benefits, services, and payment determinations.

Responsibilities

• Receive, interpret, and accurately respond to provider inquiries, both verbally and in writing, in accordance with department standards, policies, and procedures.
• Consistently document and accurately code all inquiries within designated software applications, within required Plan timeframes and according to Plan documentation policies.
• Review, investigate, and advise providers regarding claims status and payment determinations.
• Document and track actions requested from other departments addressing provider or member inquiries and informal complaints to ensure prompt resolutions.
• Interact professionally, efficiently, and effectively with providers, management, and other departments in a caring and honoring manner.

Requirements

• High School diploma or equivalent required.
• 2-3 years of prior customer service experience required.
• Effective communication skills.

Benefits

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• DailyPay – access earned wages before payday.
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

About the Organization

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at its hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites, and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs.