Insurance Specialist

Job Title: Insurance/Claims Specialist

Location: Lehi, UT

Work Arrangement: Hybrid – 2 days onsite per week

Job Type: Contract

Job Summary

We are looking for a Insurance/Claims Specialist to support healthcare providers and their staff with questions related to claims, benefits, eligibility, and other healthcare processes.

The ideal candidate will have healthcare or medical claims experience, strong communication skills, attention to detail, and the ability to resolve provider questions efficiently.

Responsibilities

• Assist healthcare providers with questions through phone and online messaging.
• Handle questions related to claims, benefits, eligibility, and billing.
• Check patient eligibility and coverage information.
• Assist with prior authorization and coordination of benefits questions.
• Research and resolve claim-related issues.
• Document all calls and interactions accurately.
• Work with internal teams to resolve complex issues.
• Follow up on provider inquiries when needed.
• Educate providers on available online tools and resources.
• Meet required service and response-time goals.

Requirements

• 2+ years of experience in healthcare, medical claims, provider support, or healthcare customer service .
• Knowledge of medical claims and insurance processes.
• Understanding of eligibility and benefits.
• Strong verbal and written communication skills.
• Excellent attention to detail and documentation skills.
• Strong problem-solving abilities.
• Ability to work in a fast-paced environment and manage multiple tasks.
• Ability to work independently in a hybrid environment.
• Knowledge of HIPAA and patient confidentiality.

Preferred Skills

• Experience working directly with healthcare providers.
• Experience with provider portals or clearinghouses such as Availity or Zelis .
• Experience with CRM or case management systems.
• Knowledge of common claim denials and healthcare payment processes.

Work Schedule

• Hybrid position based in Lehi, UT
• 2 weekdays onsite per week .

PrideGlobal and it's affiliates offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity

PrideGlobal and it's affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment

PrideGlobal and it's affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates : Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.