Claims Specialist

Job title: Provider Support Specialist

Location: Lehi, UT- Hybrid role

Duration: 6 months

Pay rate: $22/hr - $23.15/hour

Job Description:

We are seeking a proactive, detail-oriented Provider Support Specialist Contractor to help scale the Provider Services team. In this role, you will act as a primary point of contact for healthcare providers and their staff, ensuring a seamless experience when navigating claims, benefits, and administrative processes with the company.

You will play a critical role in resolving complex provider inquiries, improving operational workflows, and influencing the overall provider experience through direct feedback and continuous process improvement.

What You'll Do

• Serve as a primary liaison between healthcare providers and the company, delivering timely, accurate, and professional support via phone and provider portal messaging
• Build and maintain strong relationships with provider offices, fostering trust and long-term partnership
• Investigate and resolve complex provider inquiries related to:
• Claims submission, status, and adjudication
• Benefit and plan interpretation
• Member cost-sharing and billing questions
• Prior authorizations and coordination of benefits
• Appeals and overpayment recoupment
• Verify and communicate patient eligibility, coverage details, and accumulator balances
• Document all interactions thoroughly and accurately within internal systems
• Collaborate cross-functionally (Claims, Product, Network, etc.) to drive timely and effective issue resolution
• Identify trends in provider issues and escalate systemic problems for root cause analysis and resolution
• Contribute to the development and refinement of internal tools, workflows, and training materials
• Educate providers on self-service tools and best practices to improve efficiency and reduce friction
• Meet or exceed established Service Level Agreements (SLAs) for response and resolution times

What Success Looks Like

• Providers receive clear, accurate, and timely resolutions with minimal follow-up
• High-quality documentation and strong attention to detail across all interactions
• Demonstrated ability to independently resolve complex and ambiguous issues
• Consistent identification of trends and proactive contributions to process improvements
• Positive feedback from providers and internal stakeholders

Basic Qualifications

• 2+ years of experience in healthcare operations, provider support, or medical claims
• Strong understanding of claims adjudication, eligibility, and prior authorization processes
• Excellent written and verbal communication skills, with the ability to explain complex information clearly
• Highly organized with strong attention to detail and documentation accuracy
• Ability to manage multiple priorities in a fast-paced, high-volume environment
• Experience working independently in a remote or hybrid setting
• Familiarity with HIPAA and patient confidentiality requirements
• Proven problem-solving skills and ability to navigate ambiguity

Preferred Qualifications

• Experience in provider-facing or B2B support roles within healthcare
• Familiarity with tools such as Availity, Zelis, or similar clearinghouse platforms
• Experience with contact center systems and case management tools (e.g., Assist)
• Understanding of common claim denial reasons and healthcare payment cycles
• Bachelor's degree in Healthcare Administration or a related field (or equivalent experience)

Tools & Systems

Experience with or ability to quickly learn:

• Provider portals and clearinghouses (e.g., Availity, Zelis)
• CRM or case management systems (e.g., Assist)
• Internal knowledge bases and documentation tools

Work Environment

This is a hybrid role based out of our Lehi office, with an expectation of being onsite at least two weekdays per week.

ABOUT US:

Russell Tobin is a leading minority-owned professional and technical recruitment and staffing advisory organization. We are comprised of specialized practices focusing on a variety of skill sets and industries. Having a depth and breadth of industry expertise, our subject matter experts are able to provide tailored and swift sourcing solutions to fulfill client hiring needs. In other words, we connect top talent with companies.

As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Russell Tobin offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.