Provider Claims Service Specialist
The Provider Claims Service Specialist is responsible for responding to provider inquiries and resolving issues related to claims processing, reimbursement, and pricing. This role acts as a liaison between providers and internal claims operations teams to ensure accurate, timely resolution and a high level of service in a fast-paced environment.
Key Responsibilities
- Research and resolve provider inquiries related to claim status, pricing, reimbursement, and contract interpretation
- Analyze claim processing issues to identify root causes and implement corrective actions
- Collaborate with internal departments (e.g., Claims, Configuration, Network Management) to address escalated issues
- Review and interpret provider contracts to ensure accurate claims adjudication
- Monitor and manage assigned work queues to meet productivity and quality standards
- Maintain detailed documentation of issue resolution and provider interactions
- Identify trends and recommend process improvements to enhance operational efficiency and provider experience
- Support provider education by explaining claim outcomes, policies, and procedures
Required Qualifications
- High school diploma or equivalent required; Associate's or Bachelor's degree preferred
- 2–4 years of healthcare claims processing or provider services experience
- Strong knowledge of medical claims adjudication and reimbursement methodologies
- Familiarity with provider contracts and pricing logic preferred
- Excellent analytical, problem-solving, and communication skills
- Ability to manage high-volume workloads and prioritize effectively
- Proficiency in Microsoft Office (Excel, Word, Outlook) and claims processing systems
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.