Job Description

Provider Specialist (Lanham, MD)

Summary

- The Provider Specialist serves as the primary point of contact for healthcare providers, hospitals, and vendor partners regarding benefit, eligibility, and claims inquiries. This role requires strong communication and problem-solving skills to ensure timely and accurate responses to providers while maintaining compliance with plan provisions, policies, and client service standards. The Provider Specialist plays a key role in fostering positive provider relationships and ensuring the efficient resolution of claim-related issues within a Third-Party Administrator (TPA) environment.

Essential Duties and Responsibilities

Respond to inbound phone calls, emails, and web inquiries from providers regarding claim status, benefits, eligibility, prior authorization, and payment information. Research and resolve complex claim inquiries and discrepancies by reviewing plan documents, system records, and claim adjudication notes. Process and track provider appeals and reconsiderations in accordance with plan policies and regulatory requirements. Document all inquiries and resolutions accurately in the system to ensure proper tracking and follow-up. Escalate issues to appropriate internal departments (Claims, Eligibility, IT, Accounting, etc.) for further research or correction as needed. Assist providers with portal registration, navigation, and troubleshooting of web-based tools. Identify trends or recurring issues impacting provider satisfaction and communicates findings to leadership. Support audit requests, reporting, and other administrative duties related to provider relations and claims resolution. Maintain confidentiality and adheres to HIPAA and company privacy standards. Deliver exceptional customer service by ensuring courteous, professional, and accurate communication in all interactions. Regular and predictable attendance is an essential function of this job.

Key Competencies for the Provider Specialist

Customer service excellence Problem solving and critical thinking Team collaboration Accuracy and attention to detail Time management Confidentiality and professionalism

Education

High school diploma or equivalent, required Associate or Bachelor's degree, preferred

Experience

2+ years of experience in healthcare customer service, claims, or provider relations, preferred within a TPA, insurance carrier, or managed care organization Working knowledge of medical billing, coding (ICD-10, CPT, HCPCS), and EOB interpretation, preferred

Skills

Strong verbal and written communication skills Proficient in MS Office and claims administration systems Detail-oriented with strong analytical and problem-solving skills Ability to multitask and manage a high volume of inquiries in a fast-paced environment Commitment to delivering high-quality service and maintaining positive provider relationships

Work Schedule -

Full time. Monday - Friday, 8:30am - 5:00pm. Required in office (no at-home days).

Competitive Benefits and Compensation Package

13 paid holidays Paid Time Off (PTO) + Pro-rated during first year of employment
+ 15 days of PTO provided in the next calendar year!
Medical, dental and vision insurance, with option for dependent coverage Employer-paid basic life Long-term disability and short-term disability insurance 401(k) with employer match Tuition reimbursement

Our Culture

BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.
Our culture focuses on three core values:
Collaboration: working together across 31 locations to achieve the best for the company and our clients Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues Integrity: doing what we say we will do. Upholding strong ethical and moral principles

ADA & EEO

Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.