Health Insurance - Stakeholder Engagement Specialist

Job description

Position Overview:
Under the direction of the Independent Dispute Resolution Entity (IDRE) Executive Director or his/her designee, the Stakeholder Engagement Specialist serves as the "face" of PRI's IDRE program. The Stakeholder Engagement Specialist applies their knowledge of and experience in arbitration, dispute resolution, federal and state law, regulatory guidance and application of policies to oversee and carry out the stakeholder engagement and outreach activities related to PRI's IDRE program. The Stakeholder Engagement Speicalist serves as a trusted party representing PRI's interests as well as the interests of stakeholders, e.g., providers, plans, payers, government, etc., in communicating IDRE decisions in accordance with applicable state or federal law. Must be experienced in engagement and communication with various members of the health community from an educational perspective. Must be able to communicate in a clear manner when explaining the relationship of applicable laws to specific disputes throughout the program and with stakeholders.
The Specialist reviews case documentation, renders independent determination, and completes required notifications and data entry. In addition, the role manages stakeholder communications such as information requests, withdrawals, and inquiries, while contributing to continuous quality improvement efforts.
Responsibilities:
- Review case documentation and render independent determinations in accordance with IDRE guidelines.
- Accurately complete case-related documentation, reporting, and government portal data entry.
- Manage stakeholder communications, including requests for information, withdrawals, and inquiries.
- Engage with clients and partners in a professional manner, representing PRI mission, vision, and values.
- Collaborate with internal teams to ensure high-quality, timely deliverables that meet contractual obligations.
- Contribute to continuous quality improvement by identifying opportunities to streamline processes and enhance stakeholder experience.
- Able to review and complete both EIS and HIS disputes it is part of the daily work.
Qualifications:
- Bachelor's degree in health care administration, Insurance, or related field (or equivalent experience).
- Minimum 3 years of experience in health insurance claims, coverage, or related field.
- Trained on both EIS and HIS review for minimum of 6 months.
- Strong analytical and problem-solving skills with ability to interpret complex documentation.
- Excellent written and verbal communication skills, adaptable across diverse audiences.
EEO Statement:
Provider Resources, LLC is an Equal Opportunity Employer. We do not discriminate against qualified applicants based upon any protected group status, including but not limited to race, religion, color, creed, sex (including breastfeeding and related conditions), gender identity/gender expression, pregnancy (including childbirth and related conditions), national origin, ancestry, age, marital status, military or veteran status, sexual orientation, genetic information, physical or mental disability or medical condition as defined by applicable equal opportunity laws. Any request for accommodation can be directed toHuman Resources.
Benefits and Compensation:
Provider Resources provides a competitive benefits package that includes access to Medical, Dental, and Vision Insurance, Life Insurance, Disability, Health Savings Account (HSA), Flexible Spending Accounts (FSA), Critical Illness, Accident, Legal and ID Theft, 401k plan, and PTO.
The anticipated salary range for fully qualified candidates applying for this role will be $61,800 - $74,800 (not including discretionary bonus, equity, and benefits). The final salary offered will be dependent on several factors that include but are not limited to relevant previous experience including duration and type of experience within the industry, education, and internal equity.
HUBZone Preference: Preference will be given to individuals who reside in, or are willing to relocate to, a recognized HUBZone area. For more information, visitGo to www.sba.gov/hubzone for more information.

About PROVIDER RESOURCES INC

Join Provider Resources (PRI) and Make an Impact in Healthcare!
At PRI, we're passionate about driving integrity and advancing quality across the healthcare system. As a trusted leader in the industry, we're tackling some of healthcare's biggest challenges-improving compliance, advancing health equity, and enhancing quality and clinical outcomes while helping organizations improve care delivery and create meaningful change.
We believe that people are at the heart of healthcare, and focus on scalable, person-centered strategies that prioritize clinical excellence and evidence-based practices. Our work supports a broad network of stakeholders, including providers, patients, caregivers, payers, and regulators. We strive to enhance experiences, improve outcomes, and foster a healthier future for all.
If you're looking to be part of a forward-thinking team that makes a difference, PRI is the place for you!