Provider Services Representative

About Our Client

The organization operates within the health insurance industry, focusing on improving health and well-being for its members and communities. It addresses challenges related to provider communication and service by maintaining strong provider relationships and offering support through multiple communication channels. The organization emphasizes a supportive work environment, ongoing employee development, and community involvement.

About the Opportunity

The Provider Services Representative serves as a front-line contact for healthcare providers, managing complex inquiries through various communication channels and ensuring accurate operational information delivery. This role is vital for maintaining positive provider relationships, resolving concerns efficiently, and supporting the organization’s mission to enhance member and community health.

Responsibilities

• Manage provider inquiries efficiently via phone, web, specialized provider portals, electronic communication, plan-to-plan chat, and professional face-to-face interactions
• Present, clarify, and discuss health insurance products, network structures, and administrative services accurately with providers
• Strive for first-call resolution on all inquiries to optimize operational workflows and promote high provider retention
• Establish and maintain positive, trust-based provider relationships by taking full personal ownership of each interaction
• Address multifaceted provider needs promptly to minimize escalation rates and ensure seamless provider service
• Support business growth and sales efforts by conducting educational provider meetings as administrative needs allow
• Maintain quality, productivity, schedule adherence, and average handle time (AHT) standards without compromising relationship quality
• Participate actively in initial, task-specific, and ongoing corporate training to stay completely current on complex products, services, and structural policies
• Improve work quality continuously by proactively learning new clinical administrative skills and adapting to optimized operational processes
• Identify, document, and report notable trending topics or systemic issues in provider inquiries directly to supervisors
• Conduct all daily professional operations in strict alignment with organizational values, ethics, and performance benchmarks

Requirements

• Demonstrated ability to understand, interpret, and apply detailed healthcare policies, with an absolute commitment to maintaining the privacy of Protected Health Information (PHI) under strict HIPAA compliance
• Proven capacity to work independently and adapt rapidly to changing assignments, shifting environments, and fluctuating call queues
• Effective verbal and written communication skills tailored for both internal corporate teams and external clinical personnel
• Technical proficiency using complex enterprise telephone systems, including Interactive Voice Response (IVR) and Automated Call Distribution (ACD) workflows
• Strong foundational PC literacy, including hands-on experience navigating the Microsoft Office Suite and multi-screen administrative software
• Minimum of one (1) year of dedicated, professional customer service experience
• High School Diploma or General Education Development (GED) equivalency required
• Preferred Qualifications: Prior experience interacting directly with healthcare providers, clinical administrative staff, or medical billing departments; Bilingual fluency in English and Spanish (written and verbal) is considered a distinct advantage

Pay Range and Compensation Package

Target compensation framework: Hourly pay and starting compensation structures are determined dynamically based upon the candidate's prior customer service tenure, healthcare industry familiarity, and specialized skill evaluations

Benefits & Perks

• Comprehensive medical, dental, and vision healthcare coverage packages
• Structured company retirement savings plan
• Robust Paid Time Off (PTO) allocation, including observed holidays and dedicated volunteer time off to support community initiatives
• Performance-driven corporate incentive plan
• Tuition reimbursement opportunities to support ongoing professional and academic development

Equal Opportunity Statement

Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note: RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.