Provider Operations Specialist

Aston Carter•Naperville, IL

1d•Hybrid

About The Position

Aston Carter is hiring for a Provider Operations Specialist! This role involves arranging with providers to complete claims, processing inquiries, handling special claims, and managing inbound/outbound calls. The specialist will also manage provider paperwork, maintain profiles, and act as a liaison with other teams for workflow management and provider support overflow. A key part of the role includes developing relationships with vendors, customers, and team members, engaging with potential leads, and providing support. Daily tasks involve documenting activities in company systems, following policies and procedures, locating providers for claims when no in-network provider is available, and responding to email inquiries. The role also requires interpreting contract language, facilitating emergency work orders, researching and arranging agreements with contractors, and negotiating terms for urgent work orders. Dispatching work orders, proactively reviewing open claims, and following up with contractors are also essential duties. The specialist will prepare and respond to data requests and execute work orders in various configurations such as Agent Desktop and CMS.

Requirements

3+ years of recent Customer Service, Operations, or Claims experience within an office environment.
Ability to handle complex situations and be a problem-solver.
Proficiency in Microsoft Office suite, including Excel and Word.
Excellent communication and follow-up skills.
Ability to work well in a fast-paced environment.
Adaptability and a strong work ethic.

Nice To Haves

Salesforce CRM Experience

Responsibilities

Arrange with appropriate network and non-network providers to complete claims that cannot be automatically dispatched.
Process provider inquiries and assist with special handling claims and service follow-up.
Handle inbound and outbound calls, manage provider paperwork, and maintain provider profiles.
Act as a liaison with other teams for Workflow/Queue Management and Provider Support overflow.
Develop and nurture relationships with key vendors, customers, and team members.
Engage daily with potential new leads and provide impeccable support to each individual.
Document and track various activities and requests in company systems.
Follow all policies and procedures for daily tasks.
Locate a provider to service claims when no in-network provider is available.
Answer incoming calls, make outbound calls, and redirect calls as required.
Respond to email inquiries and interpret contract language regarding AWR enrollments, contracts, and agreements with providers.
Facilitate emergency or urgent work orders by coordinating with both customers and contractors.
Research contractors not currently under agreement and arrange one-time agreements to complete work orders.
Negotiate with contractors to reach agreeable terms for unusual, inconvenient, or urgent work orders.
Dispatch work orders following established guidelines.
Proactively review open claims and follow up with contractors on open work orders.
Respond promptly to emails from customers and other departments regarding the status of open claims.
Prepare and respond to data requests and execute work orders, service orders, error reports, set-ups, etc., in various configurations such as Agent Desktop and CMS.