[Hiring] Provider Experience Agent @NationsBenefits, LLC

Role Description

Serves as the primary point of contact for dental providers and network partners, resolving escalated issues related to claims, credentialing, authorizations, payments, and plan-specific benefit questions. Acts as the bridge between providers and internal operations, claims, and client services teams to resolve issues quickly and prevent repeat problems.

Key Responsibilities

• Own escalated provider issues from intake through resolution, including tracking, follow-up, and root cause documentation.
• Respond to provider inquiries on claims, eligibility, benefits, fee schedules, and payment disputes within defined turnaround standards.
• Coordinate with claims, credentialing, contracting, and client services teams to resolve cross-functional issues.
• Support leased network partners and direct-contracted providers, including onboarding and orientation to NationsDental processes.
• Identify trends in provider complaints and recommend process or training fixes.
• Maintain an escalation log and report on volume, categories, aging, and resolution times.
• Educate provider offices on plan-specific benefits, authorization requirements, and billing guidelines.
• Support compliance requirements, including provider complaint handling, directory accuracy, and health plan client oversight requests.
• Participate in provider outreach, webinars, and office visits as needed.

Qualifications

• High school diploma or equivalent required; associate degree or higher in business administration, healthcare administration, or a related field preferred.
• 1 to 3 years in provider relations, provider services, or dental or health plan operations.
• Working knowledge of dental claims, CDT codes, and provider contracting concepts.
• Familiarity with Medicare Advantage or Medicaid managed care requirements preferred.
• Strong written and verbal communication, with the ability to de-escalate frustrated providers.
• Comfort managing multiple open issues and following up until they are closed.
• Proficiency with CRM or ticketing tools and Excel.
• Experience working with DSOs, group practices, or specialty provider organizations preferred.
• Comfort presenting to provider offices and practice leadership in webinars and office visits.

Requirements

• Escalation resolution within standard turnaround times.
• Provider satisfaction.
• Reduction in repeat issues by category.
• Accuracy and completeness of escalation documentation.

Benefits

• This is an opportunity to be part of an organization experiencing rapid growth and innovation within the Medicare Advantage industry.
• As a Provider Services Specialist, you won't simply close tickets—you'll strengthen provider relationships, resolve issues at the root, and help shape the future of ancillary healthcare benefits.
• Join us in our mission to become the premier ancillary benefits partner for Medicare Advantage plans while improving access to quality dental care for millions of members.