Job Description
Our client is looking for an organized and efficient Member & Provider Operations Specialist to oversee key health plan administration tasks. In this position, you will maintain data integrity across member accounts, facilitate seamless provider transitions, and manage initial claim submissions. Your accuracy will ensure our members maintain uninterrupted access to quality care and support overall operational workflows. MUST BE LOCATED in the CENTRAL TIME ZONE to be considered for this role and type 55+ WPM
salary: $22 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
- Manage incoming system tickets and online portal submissions regarding updates to member files and primary physician preference updates promptly and with high precision.
- Reassign affected patient panels and trigger official notification mailings following practitioner network departures.
- Handle complex primary care assignments by hand whenever automated enrollment rules are unable to complete the match.
- Audit customer service representative activity to identify, log, and report doctor assignment mistakes to improve quality control.
- Collect, review, and resolve undelivered mail items to ensure accurate contact information and communication records.
- Review and adjudicate initial claim submissions generated by network practitioners and plan subscribers.
Skills
- Entering Data
- Excel
- Provider Data
- Time Management
- Typing 50 WPM (1 year of experience is required)
- Claims
- Healthcare (2 years of experience is required)
Qualifications
- Years of experience: 2 years
- Experience level: Experienced
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Hourly pay, Permanent employment, Temporary work, Work experience placement, Shift work