供应商客户服务中心代表（健康保险）
Provider Customer Service Representative (Health Insurance)
你喜欢帮助他人、解答问题和解决问题吗？你有医疗/医学领域的经验，或者有兴趣在该领域发展职业吗？你是否正在寻找一个可以在家工作的机会，同时建立有意义的职业生涯？
加入我们！
我们是Sutherland，正在寻找细心、目标导向的人员，以支持我们最大的一家健康保险公司客户不断增长的需求。在此职位中，你将负责以下工作：
· 索赔与授权：处理状态查询、拒赔理由、申诉、医疗记录、研究以及EOB/EOP。
- 资格与福利：验证供应商参与情况、保险覆盖范围、医疗福利表格和资质认证。
- 电话处理：记录细节，推动解决，解释下一步操作，并教育使用自助工具（如Availity）。
- 索赔：状态、拒赔理由、申诉、医疗记录、研究/路由、EOB/EOP请求。
- 授权与UM：状态、拒赔理由、利用管理申诉、事先授权验证。
- 资格与福利：状态、福利表格解读、供应商参与、资质认证。
- 电话处理与行政：详细电话记录，解决下一步操作，向供应商教育自助工具（Availity），并处理连续电话。
- 薪资与排班：16美元/小时，提供培训，周一至周五（上午8点至下午5点 EST）。
- 福利：医疗保险/牙科/视力保险，灵活休假（培训后），公司设备，EAP/健康计划配有专职教练，员工折扣，以及80%的内部晋升率。
要求
· 教育与经验：高中文凭（或同等学历）；1–2年高流量电话中心经验。
- 技能：35–40 WPM打字速度，良好的书面和口头沟通能力，积极倾听，解决问题和多任务处理能力。
- 工作环境与技术：专用安静的工作空间，严格遵守时间安排，下载速度至少10 Mbps / 上传速度至少2 Mbps。
- 资格：必须是美国居民，并有权在美国工作。
优先资格
· 1–2年在医疗办公室、医疗保险公司、账单/编码或后台处理的经验。
此职位面向有资格在美国工作的人员开放。
EEOC和退伍军人文件
在雇佣期间，员工不会因种族、肤色、宗教、性别、国籍、年龄、婚姻状况或退伍军人身份、健康状况或残疾，或其他任何受法律保护的身份而受到歧视。
有时，政府机构需要
查看英文原文
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.
Requirements
· Education & Experience: High School Diploma (or equivalent); 1–2 years high-volume call center experience.
- Skills: 35–40 WPM typing, strong written/verbal communication, active listening, problem-solving, and multitasking.
- Workplace & Tech: Dedicated quiet workspace, strict schedule adherence, and internet speeds of at least 10 Mbps download / 2 Mbps upload.
- Eligibility: Must be a US resident authorized to work in the US.
Preferred Qualifications
· 1–2 years in a medical office, healthcare insurance, billing/coding, or back-end processing.
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.