Provider Operations Specialist

Provider Operations Specialist

Join a dynamic team as a Provider Operations Specialist, where you will manage daily interactions with providers, focusing on emergency claims. You will oversee service request hubs, including Need Provider, Emergency requests, and White Glove items, ensuring claims are processed efficiently.

Responsibilities :

• Arrange with appropriate network and non-network providers to complete claims that cannot be automatically dispatched.
• Process provider inquiries and assist with special handling claims.
• Manage inbound and outbound calls, provider paperwork, and profile maintenance.
• Liaise with other teams for Workflow / Queue Management and overflow Provider Support.
• Develop and nurture relationships with key vendors, customers, and team members.
• Engage daily with potential new leads and provide exceptional support.
• Document and track activities / requests in company systems.
• Follow all policy and procedures for daily tasks.
• Find providers to service claims when no in-network provider is available.
• Answer and redirect calls as required and respond to email inquiries.
• Interpret contract language related to AWR enrollments, contracts, and agreements.
• Facilitate the completion of emergency / urgent work orders by coordinating with customers and contractors.
• Research and arrange one-time agreements with contractors not currently under agreement.
• Negotiate with contractors for unusual, inconvenient, or urgent work orders.
• Dispatch work orders following established guidelines.
• Proactively review open claims and follow up with contractors on open work orders.
• Respond promptly to emails from customers and other departments regarding claim status.
• Prepare and respond to data requests and execute various configurations like Agent Desktop and CMS.

Essential Skills :

Work Environment :

After one month of training, enjoy a hybrid schedule with remote work on Mondays and Fridays.

Job Type & Location :

This is a Contract to Hire position based out of Naperville, Illinois.

Pay and Benefits :

The pay range for this position is $24.00 - $26.00 / hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following :

Application Deadline :

This position is anticipated to close on Nov 12, 2025.

About Aston Carter :

Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain and select administrative professions, we extend the capabilities of industry-leading companies. We are proud to be a ClearlyRated Best of Staffing double diamond winner for both client and talent service. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.