Remote Provider/Member Customer Representative (Healthcare Claims)

About the role

We are looking for a remote Provider/Member Customer Representative to support members and healthcare providers with inbound claims and provider‑relations inquiries. The position offers extensive training and a structured call‑center environment, allowing you to deliver accurate, professional assistance while working from home.

Key responsibilities

• Answer inbound claims and provider‑relations calls from members and providers.
• Research and explain claim status, eligibility, and benefits.
• Process claim adjustments, reprocessing requests, and authorizations.
• Assist with provider contract inquiries and demographic updates.
• Educate members and providers on billing protocols and claims processing.
• Request duplicate EOBs, check reissues, stop payments, and related documentation.
• Submit complaints and escalate complex issues to appropriate teams.
• Conduct outbound follow‑up calls when necessary.
• Maintain first‑call resolution and deliver exceptional customer service.

Required profile

• Bachelor’s degree.
• Strong customer‑service experience with excellent verbal and written English communication.
• Ability to work successfully in a virtual/remote environment.
• Strong interpersonal, active‑listening, and organizational skills.
• Independent problem‑solving, multitasking, and time‑management abilities.
• Professional demeanor when interacting with members, providers, and healthcare offices.

Required skills

• Proficient typing and PC skills.
• Ability to quickly learn and navigate multiple claims systems and applications.

What we offer

• Fully remote work‑from‑home position with company‑provided equipment.
• Reliable high‑speed internet required.
• Structured, queue‑based call‑center environment.
• Extensive training before handling provider‑relations and claims responsibilities.