Role Description

The Provider Inquiry Specialist is responsible for reviewing, investigating, and resolving inquiries raised by healthcare providers related to claims, eligibility, benefits, authorizations, and payment details. The role requires strong analytical skills, attention to detail, and clear written communication to ensure accurate and timely provider responses while meeting SLA and quality standards.

Key Responsibilities

• Review and investigate provider inquiries received through ticketing or portal-based systems
• Analyze inquiries related to:
  • Claim status and payment
  • Eligibility and benefits
  • Authorization status
  • Denials and adjustments
• Provide clear, accurate, and professional responses to providers with appropriate explanations
• Research claim details using payer systems and supporting tools to identify the correct resolution path
• Route inquiri...