Provider Claims Service Specialist

Role overview

The Provider Claims Service Specialist supports healthcare providers by answering questions and resolving concerns tied to claim handling, reimbursement, pricing, and related contract details. This position serves as a bridge between providers and internal claims teams, with a focus on fast, accurate resolutions and strong service quality in a busy operational setting.

What you will do

• Investigate and resolve provider questions about claim status, reimbursement amounts, pricing, and contract language
• Examine claim-processing problems to determine the underlying cause and carry out corrective steps
• Work with internal teams such as Claims, Configuration, and Network Management to close escalated cases
• Interpret provider agreements to help ensure claims are adjudicated correctly
• Track and handle assigned work queues while meeting productivity and quality goals
• Keep clear records of issue resolution steps and interactions with providers
• Spot recurring patterns and suggest improvements that strengthen efficiency and provider experience
• Help educate providers by explaining claim decisions, policies, and procedures

Required qualifications

A high school diploma or equivalent is required. An associate degree or bachelor’s degree is preferred. The role calls for 2–4 years of experience in healthcare claims processing or provider services, along with solid understanding of medical claim adjudication and reimbursement methods. Familiarity with provider contracts and pricing logic is an advantage. You should also bring strong analytical thinking, problem-solving ability, communication skills, and the capacity to manage a heavy workload while prioritizing tasks effectively. Comfort with Microsoft Office tools such as Excel, Word, and Outlook, as well as claims processing systems, is needed.

Additional information

This employer is an equal opportunity organization and considers all qualified candidates without regard to age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Applicants must have an Android or iOS device that can run the free Microsoft Authenticator app.