Healthcare Provider Inquiry Associate II

Job Summary

Responsible for reviewing, investigating, and resolving healthcare provider inquiries related to claims, eligibility, benefits, authorizations, denials, and payments.

Ensures accurate, timely, and professional responses while meeting service level agreements, quality standards, and compliance requirements.

Responsibilities

• Review and investigate provider inquiries received through portal, ticketing, and case management systems.
• Analyze inquiries related to claim status, payment, eligibility, benefits, authorization status, denials, and adjustments.
• Provide clear, accurate, and provider friendly responses with appropriate explanations.
• Research claim information using payer systems and supporting tools to determine the correct resolution.
• Route inquiries to appropriate internal teams for corrections, adjustments, or additional investigation.
• Document actions, resolutions, and provider communications accurately in tracking systems.
• Ensure adherence to service level agreements, turnaround time requirements, and quality standards.
• Manage workload effectively to support backlog reduction and aging clearance targets.
• Participate in quality reviews, calibration sessions, and audit activities to improve accuracy.
• Maintain confidentiality of member and provider information in compliance with HIPAA requirements.
• Collaborate with internal stakeholders to ensure timely issue resolution and customer satisfaction.
• Support continuous process improvement initiatives and operational excellence objectives.

Skills and Qualifications

• Any Graduate.
• Minimum 6 months experience in Healthcare BPM or Healthcare BPO.
• Knowledge of healthcare claims, eligibility, benefits, authorization, and payment processes.
• Strong analytical and problem solving skills.
• Excellent written and verbal communication skills.
• Ability to handle high volume transactions with accuracy and attention to detail.
• Experience working with provider support or provider inquiry processes preferred.
• Knowledge of healthcare terminology including CPT, ICD, EOB, authorization, deductible, and copay.
• Ability to work with multiple systems and applications simultaneously.
• Proficiency in Microsoft Office applications.
• Strong organizational and time management skills.
• Ability to work independently and as part of a team.