Provider Services Representative

Job Duties

At SFM, our Provider Service Representatives work in a team driven environment in our Insurance Operations Department. That Department is the “hub of SFM”. It is multi-functional, fast paced, and production oriented. This role has a variety of tasks which include requesting records, monitoring those requests and working with a multitude of provider/vendor relationships analyzing documentation for the retention and or retrieval of documents in accordance with established best practices and procedures. You will play a vital role in the management of workers’ compensation claims and be part of SFM’s goal of delivering unrivaled customer service seeking positive outcomes for employers and injured workers in connection with a workers’ compensation claim. Our employees are encouraged to “do the right” thing and lead from within. If you thrive in an environment that gives you lots of variety, than this position may fit your professional goals.

What You will Do:

Using proper authorization, you will request and obtain a variety of documents/records in connection with a workers’ compensation claim or legal investigation under the direction of a claims or legal representative and does so in a timely manner ensuring that all time lines are met. Using organizational skills, problem solving skills and initiative you will follow up on documents that are not received and communicate with internal customers providing updates on the status of requests and dig into files to find missing information.

Forward the records received to the correct file, documents receipt of the needed records and verifies the quality of the received information while ensuring the records are organized and presentable for the customer, and provide regular updates concerning the status of request.

Reviews, authorizes, submits, and reconciles invoices for requested records using State specific regulations, internal policies and guidelines as well analyzing, troubleshooting and responding to inquiries related to duplicate payments and pursues active reconciliation to include recovery of funds as needed.

Provides guidance concerning SFM’s billing practices and acts as a resource for providers concerning bills submitted for payment while looking for efficiencies improving e-billing opportunities and troubleshooting areas of discrepancy concerning bills submitted for payment and created documentation as needed.

Handles complex matters and deals with escalated situations and issues with limited supervision and may contribute to miscellaneous team tasks when needed and acts as a liaison with medical providers and other vendors, resolving billing inquiries and gathering additional information as necessary.

Maintains the internal medical provider and legal database tables, making accurate updates when needed and handles W-9 tax forms when appropriate for the maintenance of the medical provider table as well as handling monthly and quarterly reports pertaining to the vendor and provider table and its information integrity.

Follows State and Federal regulations, as well as comply with HIPPA requirements, internal policies and guidelines while requesting confidential information and records. Manages confidential information with discretion and good judgement in accordance with team and Company guidelines.

Provides a high level of customer service for all business partners and customers while adhering to the Company’s service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality service to internal and external customers and all business partners.

Minimum Education Required

Associates degree, or equivalent work experience relevant to the role.

Minimum Experience Required

Four or more years’ experience working in an insurance operations environment processing medical claims/bills, workers’ compensation claims, commercial or property casualty insurance claims or related field.

Demonstrated experience providing customer driven solutions, support, and/or service.

Excellent customer service abilities and able to manage difficult situations effectively.

Strong working knowledge handling workers’ compensation, property/casualty, health insurance claims, or processing insurance policies is highly desirable.

Exceptional communication/interpersonal skills and ability to interact within a diverse team environment and collaborate with other business partners.

Excellent oral, written communication and presentation skills.

Excellent MS Office software applications (Excel, Word, ) and familiarity with working within a paperless environment.

Strong attention to detail with the ability to verify and cross check

Strong organizational, time management and troubleshooting skills.

Must be able to work on business premises as

Shift

First (Day)

Number of Openings

1

Compensation

$55,000.00 - $78,000.00

Postal Code

55431

Job Type

Full Time

Place of Work

Hybrid

Requisition ID

87068

Job Benefits

Comprehensive medical, dental, and vision coverage (plus HSA/FSA options).

Significant Cash Benefit if You Opt Out of Our Health Plan

Flexible hybrid work environment.

401(k) with both Traditional and Roth options + company match.

Contributions toward student loan repayment.

Generous PTO, 9 paid holidays, and paid parental leave.

Monthly home internet allowance.

Free life insurance, short-term & long-term disability coverage.

Incentive bonus opportunities.

Adoption financial assistance.

Pet insurance.

Annual company-wide volunteer day.

Discounts on gyms, fitness apps, and wellness programs.