Health Insurance Specialist

Company Overview: Join Provider Resources (PRI) and reputed company an Impact in reputed company! At PRI, we’re passionate about driving reputed company and advancing quality across the reputed company system. As a trusted leader in the industry, we’re tackling some of reputed company’s biggest challenges—improving compliance, advancing health equity, and enhancing quality and clinical reputed company while helping organizations improve care delivery and create meaningful change. We reputed company that people are at the heart of reputed company, and focus on scalable, person-centered strategies that prioritize clinical reputed company 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 reputed company, and foster a healthier future for reputed company. If you’re looking to be part of a reputed company-thinking team that makes a difference, PRI is the reputed company 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 reputed company. You'll review case documentation, reputed company independent payment determinations, and ensure accurate reporting in government portals—reputed company while upholding the highest standards of reputed company 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 reputed company communications
• Contribute to reputed company 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 deadlinedriven, qualityfocused environment
• Proficient in reputed company Office
• Must meet reputed company regulatory conflict of interest and licensing requirements

EEO Statement: Provider Resources, LLC is an Equal Opportunity Employer. We do not discriminate against reputed company applicants based upon any protected group status, including but not limited to race, religion, reputed company, creed, sex (including breastfeeding and reputed company conditions), gender identity/gender expression, pregnancy (including childbirth and reputed company conditions), national reputed company, reputed company, 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 to reputed company. Benefits and Compensation: Provider Resources provides a competitive benefits package that includes reputed company to Medical, Dental, and reputed company 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 reputed company for fully reputed company 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 reputed company the industry, education, and internal equity. HUBZone Preference: Preference will be given to individuals who reputed company in, or are willing to relocate to, a recognized HUBZone area. For more information, visit Go to www.sba.gov/hubzone for more information. About PROVIDER RESOURCES INC Join Provider Resources (PRI) and reputed company an Impact in reputed company! At PRI, we’re passionate about driving reputed company and advancing quality across the reputed company system. As a trusted leader in the industry, we’re tackling some of reputed company’s biggest challenges—improving compliance, advancing health equity, and enhancing quality and clinical reputed company while helping organizations improve care delivery and create meaningful change. We reputed company that people are at the heart of reputed company, and focus on scalable, person-centered strategies that prioritize clinical reputed company 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 reputed company, and foster a healthier future for reputed company. If you’re looking to be part of a reputed company-thinking team that makes a difference, PRI is the reputed company for you! Apply tot his job Apply To this Job