Careington Career:
Provider Relations Quality Assurance Specialist

JOB DETAILS APPLY NOW

Duties & Responsibilities:

  • Act as liaison between members, providers, and groups
  • Ensure all phone calls are answered timely and that the caller's questions are addressed entirely
  • Receive and respond to inquiries by multiple forms of communication including, but not limited to email, physical mail, telephone, and fax
  • Contact provider offices timely to resolve member billing and quality of care grievances in an urgent manner
  • Negotiate refunds from provider offices on behalf of the member if overbilling has occurred
  • Professionally write precise resolution letters and emails to members and groups
  • Educate provider offices on plan administration, plan participation, and other facets of Careington's network
  • Must be able to handle all types of provider calls, including escalations
  • Audit offices for participation and plan administration
  • 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
  • Must possess high level problem solving and analytical thinking skills that will assist in making independent judgment decisions to provider/member inquiries
  • 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 inquiries 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
  • Must be able to resolve provider calls effectively and efficiently, with the intent for one-call-resolutions
  • Ability to work independently and easily with others
  • Able to adapt quickly to departmental changes
  • Have a strong desire to meet the department's overall goals

Minimum Qualifications and Requirements:

  • High School Diploma or equivalent, some college preferred but not required
  • Proficient in: Word, Adobe, Excel, Outlook, etc.
  • Any dental knowledge is a huge plus

Ready to apply?


If you are interested in this position, click the button below to send us your resume with the job title as the subject line.

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Company information

Careington International Corporation
Attention: HR Department
7400 Gaylord Parkway
Frisco, Texas 75034
Email: [email protected]


Please note:

For immediate consideration, please email your resume along with your salary requirements.

No phone calls and no agencies please. Careington is an equal opportunity employer.

DISCLOSURES:
THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance.
This plan does not meet the minimum creditable coverage requirements under M.G.L. c.111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act. This is not a Medicare prescription drug plan. The range of discounts will vary depending on the type of provider and service. The plan does not pay providers directly. Plan members must pay for all services but will receive a discount from participating providers. The list of participating providers is at www.careington.com. A written list of participating providers is available upon request. You may cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund, less a nominal processing fee (nominal fee for MD residents is $5, AR and TN residents will be refunded processing fee). Discount Plan Organization and administrator: Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034; phone 800-441-0380.

This plan is not available in Vermont or Washington.

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