Provider Claims Customer Service Representative - Remote

Provider Claims Customer Service Representative - Remote

Job Type: Full-time - 100% Remote Position

Schedule: Monday-Friday, 11am - 7:30pm EST

Pay: $16.00 - $17.00 per hour 

We are seeking a Provider Claims Customer Service Representative to support inbound calls from healthcare provider representatives requesting claim status information. This role is responsible for researching claims within client systems and providing clear, accurate, and timely information to callers.

The ideal candidate is reliable, customer-focused, efficient, and comfortable working in a fast-paced, performance-driven contact center environment.

Key Responsibilities

• Answer inbound calls from healthcare provider representatives regarding claim status.
• Research claims and claim status information using client systems and platforms.
• Clearly and accurately communicate available claim information to provider representatives.
• Verify appropriate information before discussing claim details.
• Navigate multiple applications while actively assisting callers.
• Document calls and actions accurately in accordance with established procedures.
• Identify inquiries requiring additional assistance and follow established escalation procedures.
• Maintain professional and effective communication throughout provider interactions.
• Consistently achieve established productivity, quality, attendance, and service expectations.
• Participate in training, coaching, and ongoing professional development activities.
• Follow established privacy, security, client, and organizational requirements.

Role Expectations

This position supports a fast-paced healthcare provider contact center and requires representatives to efficiently research and communicate claim status information throughout the workday.

Successful candidates must be comfortable:

• Managing a consistent volume of inbound provider calls.
• Researching claim information swiftly and accurately.
• Navigating multiple systems while actively speaking with callers.
• Communicating clearly and professionally with healthcare provider representatives.
• Following established processes and escalating inquiries appropriately when additional assistance is required.
• Working independently in a fully remote environment.
• Receiving feedback and coaching in support of continuous improvement.
• Adapting to changing procedures, client requirements, and business needs.

This is primarily an inbound provider-facing contact center role focused on claim status inquiries and does not involve claims adjudication.

Required Qualifications

• 2+ years of previous customer service or contact center experience.
• Strong verbal communication and active listening skills.
• Ability to communicate information clearly, accurately, and professionally over the phone.
• Strong attention to detail.
• Ability to navigate multiple computer systems while actively handling calls.
• Ability to manage workload effectively and meet productivity and quality expectations.
• Ability to work independently and collaboratively within a remote team environment.
• Reliable attendance and ability to maintain an established work schedule.

Preferred Qualifications

• Experience supporting healthcare providers, provider offices, or medical billing organizations.
• Familiarity with HIPAA, healthcare claims and claims terminology.
• Experience researching medical claim status within payer, health plan, TPA, or managed care systems.
• Familiarity with common claim statuses, including paid, denied, pending, and in-process claims.
• Experience working within established contact center metrics, including average handle time, quality, productivity, and schedule adherence.
• Experience navigating multiple systems simultaneously while assisting callers.

What Success Looks Like

Successful Provider Claims Customer Service Representatives consistently:

• Provide accurate and professional claim status information to provider representatives.
• Navigate client systems efficiently and effectively.
• Balance call efficiency with accuracy and service quality.
• Communicate clearly and professionally with callers.
• Demonstrate accountability and ownership of their work.
• Maintain strong attendance and schedule adherence.
• Follow established processes and escalate appropriately when needed.
• Meet established productivity and quality expectations.
• Receive and apply coaching in support of continuous improvement.

Why You’ll Love Working with Us:

• 🏠 Work Remotely
• 💰 Competitive Pay
• 🩺Comprehensive Benefit Structure
• 💻 Equipment Provided – Everything you need to succeed
• 🚀 Career Growth – Be part of a dynamic and supportive team that values your expertise

WORK FROM HOME REQUIREMENTS

•  High Speed Internet of 25MBPS download and 5MBPS upload. You will be required to provide a speed test.
•  Ability to directly hardwire to your modem
•  Required to have a quiet dedicated work area.

About Imagenet 

Imagenet is a technology-forward healthcare operations partner with more than 25 years of experience helping healthcare payers manage critical administrative and operational processes. Founded in 2000 and headquartered in Tampa, Florida, Imagenet supports 150+ health plans through its payer clients.

Our teams help improve efficiency, accuracy, visibility, and service across complex healthcare operations, including digital mailroom, claims adjudication, contact center, member communications, and related administrative functions. By combining experienced operational teams, proven processes, and purpose-built workflow technology, Imagenet helps payers keep essential processes moving for the members, providers, and communities they serve.

Imagenet operates 10 secure facilities across the U.S. and one secure facility in Manila, Philippines.

Joining Imagenet means contributing to work that supports the healthcare operations members and providers rely on every day.