Provider Specialist (Lanham, MD)

Summary - The Provider Specialist serves as the primary point of contact for healthcare providers, hospitals, and vendor partners regarding benefit, eligibility, and claims inquiries. This role requires strong communication and problem-solving skills to ensure timely and accurate responses to providers while maintaining compliance with plan provisions, policies, and client service standards. The Provider Specialist plays a key role in fostering positive provider relationships and ensuring the efficient resolution of claim-related issues within a Third-Party Administrator (TPA) environment.

Essential Duties And Responsibilities

• Respond to inbound phone calls, emails, and web inquiries from providers regarding claim status, benefits, eligibility, prior authorization, and payment information.
• Research and resolve complex claim inquiries and discrepancies by reviewing plan documents, system records, and claim adjudication notes.
• Process and track provider appeals and reconsiderations in accordance with plan policies and regulatory requirements.
• Document all inquiries and resolutions accurately in the system to ensure proper tracking and follow-up.
• Escalate issues to appropriate internal departments (Claims, Eligibility, IT, Accounting, etc.) for further research or correction as needed.
• Assist providers with portal registration, navigation, and troubleshooting of web-based tools.
• Identify trends or recurring issues impacting provider satisfaction and communicates findings to leadership.
• Support audit requests, reporting, and other administrative duties related to provider relations and claims resolution.
• Maintain confidentiality and adheres to HIPAA and company privacy standards.
• Deliver exceptional customer service by ensuring courteous, professional, and accurate communication in all interactions.
• Regular and predictable attendance is an essential function of this job.
  
  
  

Key Competencies for the Provider Specialist

• Customer service excellence
• Problem solving and critical thinking
• Team collaboration
• Accuracy and attention to detail
• Time management
• Confidentiality and professionalism
  
  
  

Education

• High school diploma or equivalent, required
• Associate or Bachelor's degree, preferred
  
  
  

Experience

• 2 years of experience in healthcare customer service, claims, or provider relations, preferred within a TPA, insurance carrier, or managed care organization
• Working knowledge of medical billing, coding (ICD-10, CPT, HCPCS), and EOB interpretation, preferred
  
  
  

Skills

• Strong verbal and written communication skills
• Proficient in MS Office and claims administration systems
• Detail-oriented with strong analytical and problem-solving skills
• Ability to multitask and manage a high volume of inquiries in a fast-paced environment
• Commitment to delivering high-quality service and maintaining positive provider relationships
  
  
  

Work Schedule - Full time. Monday - Friday, 8:30am - 5:00pm. Required in office (no at-home days).

Competitive Benefits And Compensation Package

• 13 paid holidays
• Paid Time Off (PTO)
• Pro-rated during first year of employment
• 15 days of PTO provided in the next calendar year!
• Medical, dental and vision insurance, with option for dependent coverage
• Employer-paid basic life
• Long-term disability and short-term disability insurance
• 401(k) with employer match
• Tuition reimbursement
  
  

Pay - The pay for this position is $21.68 per hour. Actual salary is dependent on skills, experience, education, and other business factors.

Our Culture

BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees’ successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.

Our culture focuses on three core values:

• Collaboration: working together across 31 locations to achieve the best for the company and our clients
• Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
• Integrity: doing what we say we will do. Upholding strong ethical and moral principles
  
  
  

ADA & EEO

Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.