Customer Service Representative - Provider Services

Provider Service Representative

The Provider Service Representative serves as an advocate for Health Plan customers — including providers, vendors, and facilities — by offering clear guidance and education on eligibility, benefits, claim status, and other inquiries. In this role, you'll work to resolve questions quickly and professionally, ensuring every interaction is handled with care and accuracy.

While maintaining call quality and service standards, you'll play a key role in supporting providers and strengthening their confidence in the Health Plan.

The current pay rate for this position is $21.70/hour. In addition, employees receive comprehensive benefits and have a clear career path for growth and advancement. We also provide a comprehensive on-the-job training program to set you up for success.

Employees in this role should reside within 90 miles of Pittsburgh or Erie. The standard operating hours are Monday through Friday, 8:00 a.m. – 5:00 p.m.

This role offers the opportunity to work from home, with in-office options available if preferred.

What a Provider Advocate Does:

• This is a challenging position that requires great multitasking skills, quick thinking, and the ability to stay focused while working on a computer and helping our providers at the same time!
• Serve as the primary point of contact for providers and vendors, addressing inquiries related to claims, benefits, authorizations, billing, and network participation.
• Respond to inbound calls, emails, and chats from provider offices and vendor representatives with accuracy and professionalism.
• Clearly explain processes, policies, and system navigation, ensuring providers understand requirements and next steps.
• Resolve issues efficiently and thoroughly to minimize repeat contacts and enhance provider satisfaction.
• Conduct detailed research on claims, benefits, and system updates to deliver informed and timely solutions.
• Initiate follow-up communication when additional information is required to complete a request.
• Accurately document all interactions and actions in internal systems to maintain comprehensive records.
• Navigate multiple systems and tools simultaneously while maintaining focus and responsiveness.
• Manage a variety of tasks in a fast-paced environment, demonstrating strong organizational skills and composure under pressure.
• Stay current on health plan policies, procedures, and system enhancements through ongoing training and self-directed learning.
• Collaborate with team members and participate in skill-building sessions to support continuous improvement.
• Make outbound calls to provide updates, reminders, or resolutions as needed.
• Demonstrate professionalism, patience, and a commitment to service excellence in every interaction.

Minimum Internet Service Requirements:

Minimum speed and latency requirements:

• 20 mbits download or greater.
• 5 mbits upload or greater.
• Less than 50ms ping, and under 10 ms jitter.

The following types of internet services are not compatible/not allowed:

• Satellite
• Hotspot/cell phone
• DSL
• The equipment must be connected directly to the internet modem/router with an ethernet cable. WiFi, network extenders, Powerline adapters, and other adapters are not allowed. A speed test will also be required upon accepting an offer.

Qualifications:

• High school graduate or equivalent.
• 2 years customer service experience or call center experience required OR 1 year health insurance call center and claims adjustments experience required.
• Proficient in typing and writing skills required.
• Ability to make independent decisions required.
• Knowledge of Microsoft Office and Excel spreadsheet program preferred.
• Complex analytical skills necessary to evaluate customer inquiries.
• Demonstrates good organizational skills.
• A desire to help others and portray empathy in all situations.
• Ability to learn complex health plan information.
• Demonstrate flexibility and motivation to learn & grow in the position.
• Flexibility in work schedule
• Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran