Provider Customer Service Representative (Health Insurance)

Sutherland is seeking a Provider Customer Service Representative to support the needs of a health insurance company customer. The role handles provider inquiries related to claims, authorizations, eligibility, benefits, and credentialing while documenting calls, resolving issues, and educating providers on self-service tools.

Responsibilities:

• 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

Requirements:

• High School Diploma (or equivalent); 1–2 years high-volume call center experience
• 35–40 WPM typing, strong written/verbal communication, active listening, problem-solving, and multitasking
• Dedicated quiet workspace, strict schedule adherence, and internet speeds of at least 10 Mbps download / 2 Mbps upload
• Must be a US resident authorized to work in the US
• 1–2 years in a medical office, healthcare insurance, billing/coding, or back-end processing