Provider Support Specialist

Title: Provider Support Specialist Contractor

Our client is seeking a proactive, detail oriented Provider Support Specialist Contractor to help scale the Provider Services team. In this role, you will act as a primary point of contact for healthcare providers and their staff, ensuring a seamless experience when navigating claims, benefits, and administrative processes.

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.

Pay Rate: $23/Hour

Contract: 6-months

Location: Lehi, UT (HYBRID- 2 days a week on-site)

Company: Healthcare- the leading, independent third party administrator (TPA) that brings together plan administration, cost management, and taking great care of your people all in one place.

What You’ll Do

● Serve as a primary liaison between healthcare providers and Collective Health, delivering timely, accurate, and professional support via phone and provider portal messaging

● Build and maintain strong relationships with provider offices, fostering trust and long-term partnership

● Investigate and resolve complex provider inquiries related to:

• Claims submission, status, and adjudication
• Benefit and plan interpretation
• Member cost-sharing and billing questions
• Prior authorizations and coordination of benefits
• Appeals and overpayment recoupment

● Verify and communicate patient eligibility, coverage details, and accumulator balances

● Document all interactions thoroughly and accurately within internal systems

● Collaborate cross-functionally (Claims, Product, Network, etc.) to drive timely and effective issue resolution

● Identify trends in provider issues and escalate systemic problems for root cause analysis and resolution

● Contribute to the development and refinement of internal tools, workflows, and training materials

● Educate providers on self-service tools and best practices to improve efficiency and reduce friction

● Meet or exceed established Service Level Agreements (SLAs) for response and resolution times

What Success Looks Like

● Providers receive clear, accurate, and timely resolutions with minimal follow-up

● High-quality documentation and strong attention to detail across all interactions

● Demonstrated ability to independently resolve complex and ambiguous issues

● Consistent identification of trends and proactive contributions to process improvements

● Positive feedback from providers and internal stakeholders

Basic Qualifications

● 2 years of experience in healthcare operations, provider support, or medical claims

● Strong understanding of claims adjudication, eligibility, and prior authorization processes

● Excellent written and verbal communication skills, with the ability to explain complex information clearly

● Highly organized with strong attention to detail and documentation accuracy

● Ability to manage multiple priorities in a fast-paced, high-volume environment

● Experience working independently in a remote or hybrid setting

● Familiarity with HIPAA and patient confidentiality requirements

● Proven problem-solving skills and ability to navigate ambiguity

Preferred Qualifications

● Experience in provider-facing or B2B support roles within healthcare

● Familiarity with tools such as Availity, Zelis, or similar clearinghouse platforms

● Experience with contact center systems and case management tools (e.g., Assist)

● Understanding of common claim denial reasons and healthcare payment cycles

● Bachelor’s degree in Healthcare Administration or a related field (or equivalent experience)

Tools & Systems

Experience 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 tools

Work Environment

This is a hybrid role based out of our Lehi office, with an expectation of being onsite at least two weekdays per week.