Provider support Specialist

Now Hiring: Provider Support SpecialistLocation: Lehi, UT (Hybrid – 2 days onsite)Duration: 6+ Months (Potential extension)Pay Rate: $23.15/hr (W2)Schedule: Monday – FridayJOB RESPONSIBILITIES: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 DoServe as a primary liaison between healthcare providers and our client, delivering timely, accurate, and professional support via phone and provider portal messagingBuild and maintain strong relationships with provider offices, fostering trust and long-term partnershipInvestigate and resolve complex provider inquiries related to:Claims submission, status, and adjudicationBenefit and plan interpretationMember cost-sharing and billing questionsPrior authorizations and coordination of benefitsAppeals and overpayment recoupmentVerify and communicate patient eligibility, coverage details, and accumulator balancesDocument all interactions thoroughly and accurately within internal systemsCollaborate cross-functionally (Claims, Product, Network, etc.) to drive timely and effective issue resolutionIdentify trends in provider issues and escalate systemic problems for root cause analysis and resolutionContribute to the development and refinement of internal tools, workflows, and training materialsEducate providers on self-service tools and best practices to improve efficiency and reduce frictionMeet or exceed established Service Level Agreements (SLAs) for response and resolution timesWhat Success Looks LikeProviders receive clear, accurate, and timely resolutions with minimal follow-upHigh-quality documentation and strong attention to detail across all interactionsDemonstrated ability to independently resolve complex and ambiguous issuesConsistent identification of trends and proactive contributions to process improvementsPositive feedback from providers and internal stakeholdersBasic Qualifications2+ years of experience in healthcare operations, provider support, or medical claimsStrong understanding of claims adjudication, eligibility, and prior authorization processesExcellent written and verbal communication skills, with the ability to explain complex information clearlyHighly organized with strong attention to detail and documentation accuracyAbility to manage multiple priorities in a fast-paced, high-volume environmentExperience working independently in a remote or hybrid settingFamiliarity with HIPAA and patient confidentiality requirementsProven problem-solving skills and ability to navigate ambiguityPreferred QualificationsExperience in provider-facing or B2B support roles within healthcareFamiliarity with tools such as Availity, Zelis, or similar clearinghouse platformsExperience with contact center systems and case management tools (e.g., Assist)Understanding of common claim denial reasons and healthcare payment cyclesBachelor's degree in Healthcare Administration or a related field (or equivalent experience)Tools & SystemsExperience 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 toolsWork EnvironmentThis is a hybrid role based out of our Lehi office, with an expectation of being onsite at least two weekdays 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 OpportunityPrideGlobal 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 EmploymentPrideGlobal 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.AccommodationsWe 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.