Operational Specialist

Company Description Midlands Choice is a regional preferred provider organization (PPO) offering a healthcare network of more than 20,000 physicians and other healthcare professionals, 300 hospitals, and 1,300 additional facilities. By partnering with Midlands Choice, providers agree to offer services at reduced fees, helping consumers with coverage through 150 payer partners lower their out‑of‑pocket healthcare costs. The organization’s service area covers Nebraska, Iowa, South Dakota, and portions of several neighboring states, providing broad regional access to care. Operating under the Midlands Choice name since 2001, with roots dating back to the mid‑1980s, the company is URAC‑accredited for Core and Health Provider Credentialing Standards. Midlands Choice is owned by seven of the largest healthcare systems in Nebraska and Iowa, reflecting its strong regional ties and commitment to quality. Role Description The Operations Specialist provides day‑to‑day support for operations. Assists providers and payers in registration, authorization, and administration of the Midlands Choice secure website. Assists with providing in‑depth professional, courteous, efficient, timely and accurate resolution to customer inquiries. Develops and maintains positive customer relationships and serves as the customer advocate to the company. Provides timely and accurate support to provider outreach projects, claim entry and processing, mail processing, and fee schedule requests. Qualifications Knowledge of managed healthcare systems and health insurance industry. Knowledge of HIPAA privacy and security protocols. Customer focused with the ability to proactively develop customer relationships by listening, understanding, anticipating, and providing solutions to customer needs. Ability to problem solve using analytical and independent thinking. Ability to use good judgment and sound decision‑making based on relevant information and deductive reasoning. Ability to resolve issues and conflicts while maintaining composure and confidence. Ability to adapt to change and work as a team member. Desire for continuous learning and skills improvement. Ability to communicate with supervisors, co‑workers, customers, and various business contacts in an effective, professional, courteous, and congenial manner. Ability to prioritize work and handle multiple tasks/assignments. High school diploma or equivalent. At least two years of successful experience in a customer service/claims environment required in managed healthcare. #J-18808-Ljbffr