ID: 57334
2 - 3 Years
10 Openings
Chennai

Job Title : Provider Inquiry Specialist

Location : Trivandrum / Chennai / Kochi (India)

Shift : US Shift 5:30pm to 2:30am (Night Shift) - 5 days a week (Work from Office)

Education: Graduate (Any discipline)

Experience: 3-5 years in US Healthcare operations Experience in Provider Inquiry / Provider Support / Claims / Call Center Back Office preferred

Role Summary

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 (e.g., PEAR / OneHub).
• Analyze inquiries related to:
• Claim status and payment
• Eligibility and benefits
• Authorization status
• Denials and adjustments
• Provide clear, accurate, and business friendly responses to providers with appropriate explanations.
• Research claim details using payer systems and supporting tools to identify the correct resolution path.
• Route inquiries to the appropriate internal queues or teams when corrections, adjustments, or further investigation are required.
• Document all actions and responses accurately in the case management or tracking system.
• Ensure compliance with SLA, TAT, and quality benchmarks for Provider Inquiry processes.
• Support backlog and aging clearance by prioritizing work based on turnaround requirements.
• Participate in quality feedback sessions, calibrations, and cross audits to reduce repeat errors.
• Adhere to HIPAA guidelines and organizational compliance standards at all times.

Tools & Systems (Exposure Preferred)

• PEAR Portal / PPM
• OneHub / Pulse or similar ticketing systems
• Claims processing systems (payer side)
• Aerial / CFI / Burgess / HealthRule (or equivalent payer tools)

Required Skills & Competencies

• Strong understanding of US Healthcare claims and provider support workflows
• Good analytical and problem solving skills
• Strong written communication skills (provider friendly and clear explanations)
• Ability to handle high volume, repetitive tasks with accuracy
• Attention to detail and documentation discipline
• Ability to work in a fast changing environment with shifting priorities

Preferred Skills

• Prior experience in Provider Inquiry / Provider Support / PEAR inquiries
• Experience handling claim denials, pricing, eligibility, and authorization inquiries
• Knowledge of US healthcare terminology (EOB, CPT, ICD, authorization, deductible, copay, etc.)

Key Performance Indicators

• SLA & TAT adherence
• Quality accuracy %
• Provider response accuracy and clarity
• Backlog & aging management

As part of UST, candidates are expected to demonstrate:

• Humility: Respectful collaboration and openness to feedback

• Humanity: Empathy towards members, providers, and colleagues
• Integrity: Ethical processing and strict adherence to compliance
• Customer Focus: Delivering high-quality outcomes aligned with client expectations
• Excellence: Continuous improvement and ownership of results

claims management,healthcare claims,us healthcare,hipaa,onehub,