Claims Specialist, Provider Relations

1 week ago

Roseburg, United States Umpqua Health Full time

At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together.

Umpqua Health strongly encourages applications from candidates of color as well as veterans, aiming to foster a work environment that is linguistically and culturally diverse and inclusive. Please note that at this time, Umpqua Health does not offer visa sponsorship.

The Claims Specialist, Provider Relations plays a multifaceted role in fostering positive relationships between our organization and healthcare providers. This position involves taking incoming calls from provider offices handling claims and other concerns, coordinating secret shopper calls, monitoring service access, gathering data for quality assurance measures, and performing other administrative duties. The Specialist must have excellent people skills, be proactive, and detail oriented. The candidate must also possess a passion for improving healthcare delivery and outcomes.

Your Impact:

    • Take incoming phone calls from Providers offices handling claim problems and other concerns.
    • Gather from our vendor and coordinating secret shopper calls to evaluate provider performance, customer service, and adherence to service standards.
    • Document findings accurately and provide actionable feedback to improve provider-patient interactions.
    • Collaborate with providers to address any issues or concerns related to service quality and adherence to guidelines.
    • Compile reports and presentations to communicate findings and recommend strategies for improvement.
    • Utilize healthcare management software and databases to maintain accurate records and track performance metrics.
    • Work with department to support the development and implementation of training programs to educate providers on our organization's services, protocols, and standards.
    • Assist in administrative tasks such as scheduling meetings, maintaining calendars, and coordinating logistics for events or training sessions.
    • Serve as a liaison between providers and internal departments to facilitate communication and address administrative needs.
    • Perform other duties and support deliverables as assigned by the organization to help drive our Vision, fulfill our Mission, and abide by our Organization's Values.
Your Credentials:
    • High School Diploma/GED and related field or equivalent experience
    • 1+ years of experience in provider relations, healthcare administration, or in claims or billing field.
    • Excellent customer service skills
    • Strong understanding of healthcare operations, regulations, and industry trends.
    • Excellent communication, negotiation, and interpersonal skills.
    • Analytical mindset with the ability to interpret data and identify trends.
    • Proficiency in Microsoft Office Suite and healthcare management software.
    • Experience in coordinating secret shopper calls and quality assurance monitoring preferred.
    • Ability to manage multiple tasks, prioritize responsibilities, and meet deadlines.


Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.

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