Role description
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, advantages, 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
📌 Associate II (Chennai)
🏢 UST
📍 Chennai