Customer Service - Healthcare - Early Career & Experienced

Provalus is actively hiring experienced Healthcare Agents (2 years of experience) to support data entry, inbound/outbound call, and customer support/experience activities. Bring your hands-on customer service background and hit the ground running, with additional on-the-job training and accelerated career advancement opportunities available. Main responsibilities will include transcribing customer information, answering questions from customers professionally, and responding to customer inquiries.

All positions are full-time with set schedules, professional training and development, and opportunities for career advancement. Start your career today!

WHY WORK FOR PROVALUS

Provalus is a 100% U.S.-based company on a mission to create meaningful technology and customer experience careers in rural American communities where opportunities have traditionally been limited. Instead of sending work overseas, Provalus invests in small towns—building local Centers of Excellence (including locations such as North Wilkesboro, NC and Tahlequah, OK) and developing talent from within those communities.

Key Reasons to Join Provalus

1. Real Career Path, Not Just a Job Provalus hires people and actively develops them. Many team members start with customer support and advance into higher-level technical, quality, or leadership positions. On-the-job training is provided, and the company emphasizes skills growth and internal promotion.

2. Paid Training with No Experience Barrier Formal tech experience is not required for many entry-level roles. Provalus invests in training so you can learn systems, processes, and customer support skills while getting paid. This makes it an accessible starting point for people looking to build a long-term career in technology services.

3. Full-Time Stability and Benefits Positions are full-time with set schedules. Employees receive professional development support, opportunities for advancement, and a benefits package that includes COMPANY PAID HEALTHCARE.

4. Purpose-Driven Work in Your Community Provalus is built around revitalizing rural economies. Team members work for a company that deliberately chooses small-town locations and hires locally. For many employees, this means building a career close to home while contributing to the economic growth of their own community.

5. Supportive, Team-Oriented Environment. The culture emphasizes collaboration, mentoring newer team members, and continuous improvement. Employees are encouraged to share frontline insights that improve processes and customer experience.

6. Growing Company with Expanding Opportunities Provalus continues to open and expand sites across the U.S., creating more roles and advancement paths. As the company grows, high performers have increased opportunities to take on greater responsibility, move into specialized technical work, or step into leadership.

Who Thrives at Provalus

People who succeed here typically value clear structure, customer interaction, steady full-time work, and the chance to grow skills over time. Strong communication, reliability, a calm approach under pressure, and a willingness to learn are more important than prior technical

THE JOB

Provalus is seeking a Healthcare Insurance Customer Support Representative to support claims processing, member inquiries, and customer service activities for health insurance products. This role serves as a frontline resource for members and providers, researching claims status, resolving billing and coverage issues, and ensuring accurate, timely, and compliant handling of sensitive health insurance information.

Responsibilities include:

• Research claims status, benefits, eligibility, and coverage details using available resources, CRM, and internal claims processing systems.

• Handle and resolve member and provider inquiries related to claims processing, billing disputes, coverage denials, and general customer service issues.

• Provide members and providers with clear, accurate information regarding plan benefits, coverage details, and claims status.

• Process claims-related forms, prior authorizations, appeals, and other member/provider requests accurately and within required timeframes.

• Identify and escalate priority issues (e.g., urgent claims, potential fraud/compliance concerns, complex appeals) to high-level management or specialized teams as needed.

• Route inbound calls to the appropriate internal resources, including claims, billing, or clinical teams.

• Follow up on complicated or unresolved claims and member calls, ensuring timely resolution and clear communication with the member/provider.

• Complete detailed call notes and claims documentation, updating records accurately in the CRM and claims processing systems.

• Obtain and evaluate all relevant data — including medical claims, billing codes, and policy information — to accurately handle complaints and inquiries.

• Record details of comments, inquiries, complaints, and actions taken in compliance with HIPAA and company documentation standards.

• Maintain strict confidentiality of protected health information (PHI) and personally identifiable information (PII) in accordance with HIPAA and applicable regulations.

• Manage administrative tasks, and communicate and coordinate with internal departments (e.g., claims, billing, provider relations, clinical review).

• Stay current on health plan offerings, claims processing procedures, coding basics, and regulatory/compliance requirements.

• Other duties as assigned.

Role Requirements include:

• Must have an HS Diploma or GED.

• Prior experience in healthcare, health insurance, medical billing, or claims processing preferred.

• Familiarity with healthcare terminology, basic medical billing/coding concepts (e.g., ICD-10, CPT), and insurance claims processes preferred.

• Understanding of HIPAA requirements and commitment to maintaining strict confidentiality of PHI/PII.

• Ability to work onsite at the Provalus office. No remote positions are available currently.

• Excellent communication skills, including verbal and written communication, particularly when explaining complex claims or coverage information clearly.

• Ability to work effectively with others in a team environment.

• Good computer and multi-tasking skills, with the ability to navigate multiple systems (CRM, claims platforms) simultaneously.

• Competency in related computer applications.

• Strong attention to detail and accuracy, given the sensitivity of healthcare and claims data.

• Ability to react effectively and calmly in stressful situations, including when handling frustrated members or complex claims disputes.

Job Type: Full-time Work Location: In person