Provider Claims Svcs Spec

Job Profile Summary

The Provider Claims Service Specialist is responsible for responding to provider inquiries and resolving issues related to claims processing, reimbursement, and pricing. This role acts as a liaison between providers and internal claims operations teams to ensure accurate, timely resolution and a high level of service in a fast-paced environment.

Key Responsibilities

Research and resolve provider inquiries related to claim status, pricing, reimbursement, and contract interpretation

Analyze claim processing issues to identify root causes and implement corrective actions

Collaborate with internal departments (e.g., Claims, Configuration, Network Management) to address escalated issues

Review and interpret provider contracts to ensure accurate claims adjudication

Monitor and manage assigned work queues to meet productivity and quality standards

Maintain detailed documentation of issue resolution and provider interactions

Identify trends and recommend process improvements to enhance operational efficiency and provider experience

Support provider education by explaining claim outcomes, policies, and procedures

Required Qualifications

High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred

2–4 years of healthcare claims processing or provider services experience

Strong knowledge of medical claims adjudication and reimbursement methodologies

Familiarity with provider contracts and pricing logic preferred

Excellent analytical, problem-solving, and communication skills

Ability to manage high-volume workloads and prioritize effectively

Proficiency in Microsoft Office (Excel, Word, Outlook) and claims processing systems

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.