Claims Examiner

Date:  Oct 26, 2023


Remote, Remote, US

Requisition ID:  5276


Are you ready to take your next big career step with a respected BPO services company? Join us at Firstsource Transaction Services! We are a leading Business Process Management company, providing customer-centric business process services. With a diverse array of resources, we can tap into our talent pools to ensure client proximity, deep market and domain expertise, and superior communication; called our ‘Right-shore’ delivery model. We leverage this model to serve organizations in the Banking, Financial Services and Insurance, Healthcare, Telecommunications & Media verticals. Our brand’s promise is – Business Process. Simplified.

Due to our continued growth, Firstsource is looking for Provider Data Specialist

Responsible for performing manual provider demographic and contract linkage loads and maintenance based on work requests for physician groups, while ensuring we synchronize multiple systems platforms. 

Qualifications – External


  • Processing and data entry for routine types of physician and contract linkage transactions such as:
    • Load new physician demographics and contract linkage using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.)
    • Perform physician demographics and contract linkage data using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.)
    • Responsible for ensuring all data elements necessary to complete the request are provided and responds to the submitter with a detailed outline if additional information is needed
    • Use desk-top macros whenever possible to ensure data loading accuracy and efficiency
    • Send large requests capable of being automated as defined by management to the AST
  • Provide excellent customer service to customers (physician, health plans, affiliates, delegates, insured, and all associated business partners) by:
    • Quickly and accurately identifying and assessing customer needs and taking appropriate action steps to satisfy those needs
    • Solve problems systematically using sound business judgment and following through on commitments using an automated approach whenever possible
    • Respond to customers in a polite and professional manner
    • Complete assigned work within established TAT and Quality metrics while remaining within downtime parameters to ensure customer satisfaction
    • Establish successful working relationship with business partners
  • Ability to resolve quality validation issues concerning any quality process
  • Consistently meet established service, productivity, and quality standards
  • Special projects as required



  • High school diploma or equivalent
  • Basic knowledge of the health care industry and managed care preferred
  • Working knowledge of systems platforms preferred
  • Excellent telephone/customer service skills required
  • PC skills (Power Point, Word, Excel, Access, Lotus Notes, Intranet) preferred
  • Data entry experience preferred
  • Strong customer service orientation required
  • Excellent attendance
  • Ability to work independently

Critical Success Factors

  • Strong communication skills
  • Attention to detail
  • Quality focused
  • Decision making skills
  • Organizational skills
  • Problem solving
  • Team player
  • Self starter who needs minimal direction

We are an Equal Opportunity Employer.  All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.