Banner Health · 15 hours ago
Provider Experience Representative Banner Plans and Networks
Tucson, AZ
Full-time
Hybrid
Mid Level
3+ years expBanner Health is a nationally recognized healthcare leader that integrates Medicare and private health plans. As a Provider Experience Representative, you will provide customer service to physicians and their staff, answering inquiries related to coverage, benefits, and claims while ensuring excellent service and resolution on the first call.
Health CareInsuranceNon Profit
Responsibilities
Receives, documents, researches and responds to provider inquiries and escalated calls following established policies and procedures and compliance guidelines
Works cohesively with appropriate parties to ensure delivery of outstanding customer service while facilitating timely research and issue resolution, in a positive work environment, that supports the department’s ongoing goals and objectives
Provides timely and accurate information to providers regarding claims, benefits, member out-of-pocket expenses, and payments via telephone or in writing
Verifies adjudicate claim payments independently and in accordance with plan guidelines
Performs analysis and appropriate follow-up while working with many individuals to acquire necessary materials and information, including, but not limited to: physicians, facility staff, professional staff and physicians’ office staff
Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues
Serves as a resource for internal and external clients to interpret contract language and resolves contract issues by reviewing and interpreting contract terms
Assists internal departments in resolving provider appeals pertaining to the organization’s physicians, hospitals, and insurance plan contracts
Provides education to physicians and their office staff, hospitals and the organization’s insurance plan administration staff
Works on special projects as assigned
Services inbound and outbound providers and office staff communications for all facilities and/or physician offices in the states in which they operate
Works under limited supervision with various departments and staff to provide for diverse customer service needs for a comprehensive provider network
Makes decisions within structured definitions and defined policy
Work requires the constant exercise of a high degree of independent judgment in response to complex and sensitive provider issues, decision making and discretion
Handles physician inquires and problems within the scope of the job function and keeps supervisors apprised of all issues they occur
Meet quality, quantity, and timeliness standards to achieve individual department performance goals as defined within the department guidelines and compliance standards
In addition, the incumbent must have excellent verbal and written communication skills, determine work priorities, and is expected to accomplish all tasks with minimal supervision and instruction
Qualification
Required
High school diploma/GED or equivalent working knowledge
Must have substantial previous related work experience in healthcare services, with three to four years of experience in a high volume service center or managed care environment
Ability to multitask between inbound calls, searching the database or resource tools for correct and timely information, and maintain a professional demeanor at all times
Must have excellent communication skills, both verbal and written, while maintaining a positive and helpful attitude with customers
Must demonstrate an ability to meet deadlines in a multi-functional task environment
Requires excellent organizational skills and operational knowledge working with work processing, spreadsheets, data entry, fax machines, and other computer related skills
Must have the ability to acquire and utilize a sound knowledge of the company's provider information systems, as well as, fundamental knowledge of the organization's expectations
Must, at all times, maintain efficiency and timeliness in all daily activities
Must be able to establish daily work priorities and work efficiently to contribute to the successful overall provider experience
Preferred
Experience with a strong knowledge of business and/or healthcare as normally obtained through the completion of an associate's degree
The knowledge of medical claims typically acquired over one to two years of work experience in medical claims adjudication, contract interpretations, billing and coding, and medical terminology
Company
Banner Health
Banner Health operates as a nonprofit health care system in the United States. The company offers hospital care, home care, hospice care,
10001+ employees
H1B Sponsorship
Banner Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (76)
2024 (70)
2023 (35)
2022 (47)
2021 (51)
2020 (29)
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Diane and Bruce Halle Foundation
2025-10-24Grant
Leadership Team
Andy Kramer Petersen
President & CEO Banner Health Foundation
Brian P. Kellar
Chief Executive Officer
Recent News
2025-12-15
2025-12-10
2025-11-21
Company data provided by crunchbase