Claims Specialist in American Fork, Utah

Provider Support Specialist Contractor

Location:

Lehi, UT

Work Arrangement:
Hybrid - Onsite at least 2 weekdays per week

Contract Type: 5 months contract Pay Range - $21.00/hr.

- $23.00/hr

We are seeking a proactive and detail-oriented Provider Support Specialist Contractor to support and scale a Provider Services team. In this role, you will serve as a primary point of contact for healthcare providers and their staff, helping them navigate claims, benefits, eligibility, prior authorizations, and other administrative processes. You will play an important role in resolving complex provider inquiries, improving operational workflows, and enhancing the overall provider experience through effective communication, issue resolution, and continuous process improvement.

• Serve as a primary liaison between healthcare providers and the organization through phone and provider portal messaging.
• Build and maintain strong relationships with provider offices while delivering timely, accurate, and professional support.
• Investigate and resolve 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 over payment recoupment
• Verify and communicate patient eligibility, coverage information, and accumulator balances.
• Accurately document provider interactions and resolutions in internal systems.
• Collaborate with cross-functional teams, including Claims, Product, Network, and other internal departments, to resolve issues efficiently.
• Identify trends in provider inquiries and escalate systemic issues for root-cause analysis.
• Contribute to improving internal tools, workflows, processes, and training materials.
• Educate providers on self-service tools and best practices to improve efficiency.
• Meet or exceed established Service Level Agreements (SLAs) for response and resolution times.

• 1+ 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.
• Ability to explain complex healthcare information clearly and effectively.
• Strong organizational skills and attention to detail.
• Ability to accurately document and manage multiple cases simultaneously.
• Comfortable working in a fast-paced, high-volume environment.
• Ability to work independently in a remote or hybrid setting.
• Familiarity with HIPAA and patient confidentiality requirements.
• Strong problem-solving skills and ability to navigate ambiguity.

Pride Global and its affiliates offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.

Pride Global and its affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Pride Global and its affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates:
Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.