Process Associate

Job Summary

The Provider Service Center Agent acts as the primary liaison between the healthcare payer and its contracted providers. This role is responsible for handling provider inquiries related to claims, eligibility, benefits, authorizations, and provider data while ensuring adherence to US healthcare regulations, payer policies, and service-level agreements (SLAs).

Key Responsibilities

• Handle inbound calls, emails, and portal inquiries from physicians, hospitals, and ancillary providers

• Respond to provider questions on claims status, payment disputes, denials, and adjustments

• Verify member eligibility, benefits, and coverage details across Commercial, Medicare, and Medicaid plans

• Support prior authorization, referral, and utilization management inquiries

• Assist with provider enrollment, credentialing status, demographic updates, and contract-related requests

• Document all interactions accurately in payer systems such as CRM, claims, or provider management platforms

• Ensure strict compliance with HIPAA, CMS, and internal payer policies

• Meet defined SLAs, quality standards, and productivity metrics

• Identify trends, repeat issues, and potential process gaps and escalate when required

Required Qualifications