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About Employer Direct Healthcare

About You:

• You have a drive and AMBITION to tackle big problems. Big problems required big ideas and a team that supports new ideas.
• You CARE deeply for your customers. Your customers arent just the individuals using your product. They are the driving factor in your motivation to make a change.
• You thrive in a TEAM ENVIRONMENT(link removed) Collaboration is key in innovation and creating change.
• A DIVERSE environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
• You are DETAIL ORIENTED, but more so, focus on the execution of your content while balancing a fast-paced environment.
• You understand that PROGRESS is critical to making change. You take the time to celebrate the small and big wins. Understanding that each improvement to a process helps move towards a greater change.
• INTEGRITY guides you in life. Focusing on the truth versus just giving people the answers they want to hear.

If this sounds like you, we would love to connect to speak further about career opportunities at Employer Direct Healthcare.

Please apply to our role & someone from our HR Team will reach out to help you navigate our interview process.

Provider Claims Service Specialist

The Provider Claims Service Specialist (PCSS) is the key contact supporting network claims customer service. The PCSS is responsible for ensuring that EDH providers have dedicated support for core operational issues and inquiries. Most inquiries the PCSS encounters relate to claims (i.e., payment status and amounts paid). The PCSS builds trust and rapport with EDHs providers administrative counterparts through responsiveness, content, customer service, problem solving and a consultative mindset. Successful PCSS are highly organized, personable, resourceful, and self-starting.

THIS POSITION IS 100% ONSITE. We are located in Dallas, TX.

Responsibilities and Duties

• Develops and maintains positive relationships with the administrative contacts representing EDHs provider network, as well as key internal stakeholders (e.g., Member Services, Provider Network Solutions, Claims, etc.)
• Responsible for responding to, and resolving day-to-day provider inquiries and issues (claims inquiries, member bills):
  • Must have or learn EDH claims practices, including pricing of claims, understanding EDH claims systems, to effectively resolve provider inquiries related to claims
  • Must be able to demonstrate basic understanding of key terms within provider contracts with understanding of billing / claims and placements / referrals
  • Must be able to understand the end-to-end member experience, including the Member Services systems and workflows, to be able to resolve member bill or member placement-related issues with providers (partnering with applicable Member Services associates)
• Root cause analysis and issue prevention is also a key focus area. The goal of the PCSS is to have a continuous improvement mindset by sharing trends and process improvements that will improve the overall claims process and prevent escalations from occurring
• Partners with Regional Associates and Regional Vice Presidents in the Network Solutions team to resolve complex claims issues and discuss directly with the provider office
• May interact with members directly on high complex member billing issues

Requirements

• Bachelors degree preferred
• 2-3 years of job-related experience in a healthcare customer service, claims, provider relations, claims pricing or scheduling preferred
• Advance experience utilizing Microsoft Application
• Ability to work effectively in a team environment
• Ability to communicate clearly and professionally, both in written and verbal format
• Experience with customer service technology systems (e.g., dialers, etc.), a plus
• Excellent customer service and organizational skills, along with being a self-starter who can work with minimal supervision
• Motivated team player with a positive attitude and ability to work in fast-paced, continually changing, environment

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Short & Long Term Disability
• Life Insurance
• 401k with company match
• Paid Time Off
• Paid Parental Leave

Pay: $20-22/hour + quarterly bonus

Onsite - no remote work