Provider Service Specialist

Full time

Shift

Day Shift

Description

*REMOTE OPPORTUNITY*

This position is temporary/seasonal through April 2027. The schedule is M-F, 8am-4:30pm EST. Medicare Advantage experience would be helpful, managed care, health insurance, as well as customer service and call center experience.

Position Purpose

In accordance with the Mission and Guiding Behaviors; the Provider Service Specialist responds in a timely and accurate manner to provider inquiries made by phone, in person and in writing regarding Plan benefits, services and payment determinations.

What You Will Do

• Receive, interpret and accurately respond to provider inquiries, both verbally and in writing in accordance with department standards, policies and procedures.
• Consistently document and accurately code all inquiries within designated software applications, within required Plan timeframes and according to Plan documentation policies.
• Review, investigate, and advise providers regarding claims status and payment determinations.
• Document and track actions requested from other departments addressing provider or member inquiries and informal complaints to insure prompt resolutions.
• Interact professionally, efficiently and effectively with providers, management and other departments in a caring and honoring manner.

• Education: High School diploma or equivalent required
• Experience: 2-3 years of prior customer service experience required
• Effective Communication Skills

• Mount Carmel Health System recognized by Forbes in 2025 as one of America’s Best State Employers.
• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.