Provider Customer Service Representative (Health Insurance)

Do you enjoy helping others, answering questions and resolving problems? Do you have any experience in the healthcare/medical field or are you interested in pursuing a career in the field? Are you looking for an opportunity to build a fulfilling career while working from home ? Join Us!

We're Sutherland, and we are seeking attentive, goal-oriented individuals to support the expanding needs of one of our largest health insurance company customers. In this role, you will be responsible for the following:

Claims & Authorizations: Handle status inquiries, denial rationales, appeals, medical records, research, and EOBs/EOPs.

Eligibility & Benefits: Verify provider participation, coverage, medical benefit grids, and credentialing.

Call Handling: Document details, drive resolutions, explain next steps, and educate on self-service tools (e.g., Availity).

Claims: Status, denial rationales, appeals, medical records, research/routing, EOB/EOP requests.

Authorizations & UM: Status, denial rationales, utilization management appeals, prior auth verification.

Eligibility & Benefits: Status, benefit grid interpretation, provider participation, credentialing.

Call Handling & Admin: Thorough call documentation, resolving next steps, educating providers on self-service tools (Availity), and back-to-back call management.

Pay & Schedule: $16/hour, paid training, Mon–Fri (8 AM–5 PM EST).

Perks: Medical/dental/vision, flexible vacation (post-training), company equipment, EAP/wellness with a dedicated trainer, employee discounts, and 80% internal promotion rate.

This role is open to those eligible to work in the USA.

EEOC and Veteran Documentation During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status. At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.