Health Insurance Specialist

Job description

Company Overview:
Join Provider Resources (PRI)andMake an Impact in Healthcare!
At PRI, we're passionate about driving integrityandadvancing quality across the healthcare system.As a trusted leader in the industry, we're tackling some of healthcare's biggest challenges-improving compliance, advancing health equity,andenhancing qualityandclinical outcomes while helping organizations improve care deliveryandcreate meaningful change.
We believe that people are at the heart of healthcare,andfocus on scalable, person-centered strategies that prioritize clinical excellenceandevidence-based practices. Our work supports a broad network of stakeholders, including providers, patients, caregivers, payers,andregulators. We strive to enhance experiences, improve outcomes,andfoster a healthier future for all.
If you're looking to be part of a forward-thinking team that makes a difference, PRI is the place for you!
Position Overview:
Provider Resources is seeking a detail-oriented Health Insurance Specialist to support the Independent Dispute Resolution Entity (IDRE) program. In this role, you'll analyze payment disputes between nonparticipating providers and group health plans, applying regulatory guidance and critical thinking to determine fair payment outcomes. You'll review case documentation, make independent payment determinations, and ensure accurate reporting in government portals-all while upholding the highest standards of integrity and collaboration.
Key Responsibilities:
- Review and adjudicate payment disputes in line with IDRE policies
- Prepare determinations based on submitted documentation and select between proposed offers
- Ensure timely and precise case documentation and data entry
- Collaborate with internal teams, partners, and clients to meet contract and quality metrics
- Maintain confidentiality, compliance, and professionalism in all communications
- Contribute to continuous quality improvement and uphold organizational values
Required Experience:
- Bachelor's degree preferred; or equivalent experience.
- 2+ years of experience in health insurance claims, coverage, or administration preferred
- Strong data entry, analytical, organizational, and communication skills
- Ability to manage workloads in a deadline-driven, quality-focused environment
- Proficient in Microsoft Office
- Must meet all regulatory conflict of interest and licensing requirements
EEO Statement:
Provider Resources, LLC is an Equal Opportunity Employer. We do not discriminate against qualified applicants based upon any protected group status, including but not limited to race, religion, color, creed, sex (including breastfeeding and related conditions), gender identity/gender expression, pregnancy (including childbirth and related conditions), national origin, ancestry, age, marital status, military or veteran status, sexual orientation, genetic information, physical or mental disability or medical condition as defined by applicable equal opportunity laws. Any request for accommodation can be directed toHuman Resources.
Benefits and Compensation:
Provider Resources provides a competitive benefits package that includes access to Medical, Dental, and Vision Insurance, Life Insurance, Disability, Health Savings Account (HSA), Flexible Spending Accounts (FSA), Critical Illness, Accident, Legal and ID Theft, 401k plan, and PTO.
The anticipated salary range for fully qualified candidates applying for this role will be $50,459 - $75,723 (not including discretionary bonus, equity, and benefits). The final salary offered will be dependent on several factors that include but are not limited to relevant previous experience including duration and type of experience within the industry, education, and internal equity.
HUBZone Preference: Preference will be given to individuals who reside in, or are willing to relocate to, a recognized HUBZone area. For more information, visitGo to www.sba.gov/hubzone for more information.

About PROVIDER RESOURCES INC

Join Provider Resources (PRI) and Make an Impact in Healthcare!
At PRI, we're passionate about driving integrity and advancing quality across the healthcare system. As a trusted leader in the industry, we're tackling some of healthcare's biggest challenges-improving compliance, advancing health equity, and enhancing quality and clinical outcomes while helping organizations improve care delivery and create meaningful change.
We believe that people are at the heart of healthcare, and focus on scalable, person-centered strategies that prioritize clinical excellence and evidence-based practices. Our work supports a broad network of stakeholders, including providers, patients, caregivers, payers, and regulators. We strive to enhance experiences, improve outcomes, and foster a healthier future for all.
If you're looking to be part of a forward-thinking team that makes a difference, PRI is the place for you!