Provider Customer Service Representative (Health Insurance)

Do you enjoy helping others, answering questions and resolving problems? Do you have any experience in the healthcare/medical field or are you interested in pursuing a career in the field? Are you looking for an opportunity to build a fulfilling career while working from home ?

Join Us!

We're Sutherland, and we are seeking attentive, goal-oriented individuals to support the expanding needs of one of our largest health insurance company customers. In this role, you will be responsible for the following:

- Claims & Authorizations: Handle status inquiries, denial rationales, appeals, medical records, research, and EOBs/EOPs.
- Eligibility & Benefits: Verify provider participation, coverage, medical benefit grids, and credentialing.
- Call Handling: Document details, drive resolutions, explain next steps, and educate on self-service tools (e.g., Availity).

Responsibilities

Claims: Status, denial rationales, appeals, medical records, research/routing, EOB/EOP requests.; Authorizations & UM: Status, denial rationales, utilization management appeals, prior auth verification.; Eligibility & Benefits: Status, benefit grid interpretation, provider participation, credentialing.; Call Handling & Admin: Thorough call documentation, resolving next steps, educating providers on self-service tools (Availity), and back-to-back call management.; Pay & Schedule: $16/hour, paid training, Mon–Fri (8 AM–5 PM EST).; Perks: Medical/dental/vision, flexible vacation (post-training), company equipment, EAP/wellness with a dedicated trainer, employee discounts, and 80% internal promotion rate.

Requirements

Education & Experience: High School Diploma (or equivalent), 1–2 years high-volume call center experience.; Skills: 35–40 WPM typing, strong written/verbal communication, active listening, problem-solving, and multitasking.; Workplace & Tech: Dedicated quiet workspace, strict schedule adherence, and internet speeds of at least 10 Mbps download / 2 Mbps upload.; Eligibility: Must be a US resident authorized to work in the US.

Nice to have

1–2 years in a medical office, healthcare insurance, billing/coding, or back-end processing.