Job Title: Provider Relations Associate Analyst
Location: 100% Remote
Duration: 7 months
Shift/Hours: 

• Training Hours: 8:30 AM-5:00 PM CST
• Post-Training Hours: 10:30 AM-7:00 PM CST

Screening Questions:

1. What experience or exposure do you have in the behavioral health field?
2. Can you describe your background in customer service, including relevant roles or responsibilities?
3. Have you completed a Bachelor's degree, preferably in Healthcare Administration, Psychology, Social Work, or a related field? If so, can you provide supporting documentation?

 Important Notes:

• This position is fully remote. Candidates must be willing to complete all training and work from home.
• Reliable high-speed internet is required and must be provided by the candidate.
• Manager prefers candidates located in the U.S., ideally in PST or MST time zones, to support late shift coverage.

 Job Summary:

• Begin with training on Eligibility and Benefits calls from Behavioral Health Providers.
• After initial training, transition to handling Claim and Provider Relations (PR) calls (based on business need).
• Handle inbound claim calls from members and providers (or their office staff).
• Occasional outbound calls may be required to resolve claim issues.
• Call topics may include:
  • Claim status and reprocessing
  • Contract questions
  • Demographic updates
• Use multiple systems and applications per call.
• Requires multitasking, independent problem-solving, and strong technical skills.

 Responsibilities Include:

• Assist members/providers with understanding claim processing.
• Verify claim status.
• Educate on billing protocols.
• Write/correct authorizations.
• Request claim adjustments/reprocessing.
• Send duplicate EOBs or reissue checks.
• Follow-up on open issues via outbound calls.
• Submit complaints or escalation requests.
• Assist with provider contract/demographic updates.
• Ensure accurate information, excellent customer service, and first-call resolution.

 Skills & Qualifications:

• Customer service experience required.
• Ability to succeed in a virtual team environment.
• Strong interpersonal, communication, and listening skills.
• Excellent organizational and multitasking abilities.
• Technical proficiency with multiple systems.
• Independent problem-solving and time management.
• Strong PC and typing skills.

Education:

• Bachelor’s degree required.
• No certifications or licenses required.

Must-Haves:

• A Bachelor's degree is required, preferably in Healthcare Administration, Psychology, Social Work, Mental Health, Health Coaching, Community Health, Public Health, Family Communications, Counseling, or Community Development.
• Minimum of 1–2 years of customer service experience, ideally in healthcare, insurance, or call center environments.
• Excellent communication skills and the ability to manage high call volumes.
• Strong technical aptitude with experience using multiple systems/applications simultaneously.
• Located within the U.S. (PST or MST preferred).

 

 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $21.24/hr.