Provider Relations Specialist

About Careington:   

Careington is a solutions-oriented company. An established leader, we have been a trailblazer in the field of discount health care since 1979. Over the years, our mission has remained the same — to create discount health programs that are marketable to the employer, profitable to the provider and economical for the member. In response to a growing demand for our products and services in recent years, our growth means that we continuously strive to recruit innovators to join our fast-paced, forward-thinking team. 

We are based in Frisco, TX and employ prospective candidates that are able to work in a Hybrid work arrangement, 3 days in the office per week. If you are looking for a great company culture filled with rewarding career advancement opportunities, this is the place for you. 

The Provider Relations Q & A team is the primary liaison between Careington and our individual dental offices, and key component to educating and assisting our providers on a day-to-day basis. This role also involves working with network development’s other core divisions like recruitment and credentialing as well as working externally with Careington’s clients and their provider relations departments.

Individuals who have prior experience within the dental or medical insurance industry are strongly encouraged to apply.

Duties & Responsibilities: 

• Act as liaison between providers, members, and act as the dedicated liaison for assigned clients
• Answer phone calls from providers and handle inquiries in real time
• Resolve provider calls effectively and efficiently, with the intent for one-call-resolutions when possible
• Contact provider offices to resolve member billing and quality of care grievances
• Negotiate refunds from provider offices on behalf of the member if overbilling has occurred
• Professionally write resolution letters due to member billing or quality of care inquiries
• Educate provider offices on plan administration, plan participation, and other facets of Careington’s network by phone
• Work with marketing and team to create education materials and distribute them to the network
• Audit offices for participation and plan administration
• Work with compliance on addressing escalated issues
• Willing to perform all other responsibilities as assigned and assist in other department projects as needed
• Maintain a thorough working knowledge of Careington’s Network Development department and functions

Knowledge, Skills, and Abilities:

• Must be a self-motivator with a high desire to add value to the day to day operations of the department
• Possess high level problem solving and analytical thinking skills that will assist in making independent judgment decisions to provider/member inquiries
• Strong conflict resolution skills to de-escalate
• Have a strong sense of time management and organizational skills with the ability to effectively manage various daily tasks
• Must be able to retain and apply learned information to all request presented
• A strong knowledge of basic mathematical calculations is required
• Impeccable communication skills – both written and verbal
• Must have professional phone demeanor and superb listening skills for callers 

Minimum Qualifications and Requirements:

• College degree preferred but not required
• Proficient within MS Office Suite products: Word, Adobe, Excel, Outlook, etc.
• Any dental or medical insurance industry knowledge is a plus