Medical Claims Specialist, Remote
Gainwell Technologies
Provider Relations Manager, Healthcare
EXL
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Manage provider relations and service interactions within assigned team.
- Act as primary liaison supporting external providers with audit inquiries, claims reimbursement progress, and service-related concerns.
- Provide training and education on claims audit record submissions, timelines, and process guidelines.
- Assist providers in optimizing portal usage and understanding service enhancements.
- Identify and address operational inefficiencies and implement data-driven solutions.
- Research and resolve complex claims issues, ensuring timely and effective communication of resolutions.
- Collaborate with internal teams to improve tools, resources, and provider support systems.
- Utilize business knowledge and sound judgment to navigate ambiguous situations and address non-standard requests.
- Build and maintain strong provider relationships while aligning with company policies.
- Contribute to the success of the Provider Touch Team by fostering collaboration and enhancing the overall provider experience.
Requirements
- 4+ years of experience in healthcare or managed care settings.
- 3+ years of direct provider-facing experience.
- Intermediate knowledge of claims processing and auditing.
- Strong background in claims processing.
- Excellent verbal and written communication skills.
- Outstanding interpersonal skills with the ability to build rapport and maintain positive relationships.
- Strong customer service mindset with a solution-oriented approach.
- Solid understanding of healthcare operations and industry best practices.
- Proficiency in PC skills and data software applications.
- Bachelor's Degree.
