Healthcare Provider (Lehi)

Job Title: Provider Support Specialist (Healthcare Operations) Hybrid work - 2 days onsite 3 days WFH- Lehi, UT pay Range - $22.55/hr.- $23.15/hr. Role Overview You will play a critical role in resolving complex provider inquiries, improving operational workflows, and enhancing the overall provider experience through direct feedback and continuous process improvement. Key Responsibilities Serve as the primary liaison between healthcare providers and the organization, 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 partnerships 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 Accurately document all interactions within internal systems Collaborate cross-functionally (Claims, Product, Network teams) to ensure timely issue resolution Identify trends in provider issues and escalate systemic concerns for root cause analysis Contribute to improving internal tools, workflows, and training materials Educate providers on self-service tools and best practices to enhance efficiency Meet or exceed established Service Level Agreements (SLAs) What Success Looks Like Providers receive clear, accurate, and timely resolutions with minimal follow-up High-quality documentation with strong attention to detail Ability to independently resolve complex and ambiguous issues Proactive identification of trends and contribution 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 Strong organizational skills with high attention to detail Ability to manage multiple priorities in a fast-paced environment Experience working in a remote or hybrid setup Familiarity with HIPAA and patient confidentiality requirements Strong problem-solving skills with the ability to navigate ambiguity

PrideGlobal and it's 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.

Equal Employment Opportunity PrideGlobal and it's 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.

Fair Chance Employment PrideGlobal and it's 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.

Accommodations 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

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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.