Provider Customer Service Representative – Health Insurance

Sutherland

. Handle claims status inquiries, denial rationales, appeals, medical records, research/routing, and EOB/EOP requests .

Posted 9/21/2026full-timeRemote • Texas • EgyptJunior💰 $16 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in handling claims inquiries, authorization management, and provider verification within a health insurance context. Proficient in communication, problem-solving, and multitasking to support customer needs effectively.

Highest-signal resume keywords

Claims Status InquiriesUtilization ManagementHigh-Volume Call Center ExperienceStrong Written And Verbal CommunicationMedical Office Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingPrior Authorization VerificationTyping Speed 35–40 WPMMedical Benefit GridsCredentialing

Soft Skills

Active ListeningProblem-SolvingMultitaskingSchedule Adherence

Tools & Technologies

Availity

Certifications & Qualifications

High School Diploma Or Equivalent

Industry Keywords

Healthcare InsuranceBilling/CodingBack-End Processing

About the role

Key responsibilities & impact

Handle claims status inquiries, denial rationales, appeals, medical records, research/routing, and EOB/EOP requests
Handle authorization and utilization management status inquiries, denial rationales, appeals, and prior authorization verification
Verify provider participation, eligibility, coverage, medical benefit grids, and credentialing
Document call details thoroughly and drive resolutions
Explain next steps and educate providers on self-service tools such as Availity
Manage back-to-back calls
Support the expanding needs of a health insurance company customer

Requirements

What you’ll need

High School Diploma or equivalent
1–2 years of high-volume call center experience
35–40 WPM typing speed
Strong written and verbal communication
Active listening, problem-solving, and multitasking skills
Dedicated quiet workspace
Strict schedule adherence
Internet speed of at least 10 Mbps download and 2 Mbps upload
Must be a US resident authorized to work in the US
Role is open to those eligible to work in the USA
Preferred: 1–2 years in a medical office, healthcare insurance, billing/coding, or back-end processing

Benefits

Comp & perks

Paid training
Medical, dental, and vision insurance
Flexible vacation after training
Company equipment
Employee assistance program (EAP) and wellness program with a dedicated trainer
Employee discounts
80% internal promotion rate