Provider Customer Service Representative (Health Insurance)

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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.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...