Offer summary

Qualifications:

High School Diploma or equivalent education required., Detail-oriented with technical aptitude and ability to learn new processes., Proven problem-solving skills and effective issue resolution., Excellent written and verbal communication skills. .

Key responsabilities:

Manage provider database information and demographics.

Research and communicate discrepancies in provider data affecting claim pricing.

Validate contract pricing on claims in response to provider appeals.

Provide customer service and assist in department research activities.

Job description

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, Health Plans, Inc. (HPI) is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

What we do

HPI is unique. A respected industry leader that’s been serving customers for over 40 years, we’re known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.

What you’ll do

The Provider Pricing Specialist is responsible for managing provider database information, provider association with claim and set up of online customer portals. The Provider Specialist assists with research to settle claim pricing questions, as well as the provider and member appeal process. The Specialist provides assistance in all department research activities.

In this role, you’ll also:

Manage provider database information including demographics and associated networks.
Research and communicate any discrepancies or changes to provider data that could potentially affect how a claim is priced or paid.
Maintain unique provider data to support accurate display on provider search portal.
Validate contract pricing on paid claim in response to provider appeals and inquiries.
Provide information and customer service to internal and external customers.
Assist team in all department research activities.
Contribute to documentation and updates of all policies and procedures.

What you bring

High School Diploma or equivalent education
Must be detail oriented with demonstrated technical aptitude, including the ability to learn and apply multiple processes and adapt to new computer programs
Proven problem-solving skills with the ability to analyze and resolve issues effectively
Adhere to all department policies and procedures while achieving department productivity and turnaround time goals
Excellent communication skills, both written and verbal
Ability to work well independently and take independent action while also working successfully within a team environment
Proficiency in Microsoft Office Suite, including Word, Excel, Outlook and PowerPoint
Knowledge of medical claim coding and/or claim billing is a plus

Why choose us?.

We offer our employees flexible work arrangements including remote and hybrid options (depending on the position).
We’re a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.

Benefits

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer: