CW Provider Network Resolution Specialist

Provider Network Resolution Specialist Remote, United States Contract Assignment

Pay Rate: $25.50/hour

Target Start Date: August 10, 2026

Anticipated End Date: December 31, 2026

Schedule: Monday through Friday, 8:00 AM to 4:30 PM PST

We are seeking five detail-oriented and customer-focused Provider Network Resolution Specialists for a remote contract opportunity. This role is ideal for professionals with healthcare payer, provider relations, claims, appeals, network management, or healthcare operations experience. Selected candidates will begin on the same start date for training purposes. The Provider Network Resolution Specialist will support provider issue resolution by researching, analyzing, documenting, and resolving provider-related concerns. This may include provider disputes, billing concerns, claims issues, authorization questions, escalation trends, provider data discrepancies, network participation questions, and related operational matters. Please note that this role follows a Pacific Time schedule. Candidates must be available to work 8:00 AM to 4:30 PM PST, regardless of their local time zone.

Key Responsibilities

• Research and resolve provider network issues, including claims, billing, authorization, provider data, and participation-related concerns.
• Review provider disputes and escalation trends to identify root causes and recommend appropriate resolution steps.
• Navigate multiple internal systems, provider databases, CRM tools, claims systems, spreadsheets, and case management platforms.
• Validate information across systems to ensure provider data, documentation, and resolution outcomes are accurate.
• Document issue details, actions taken, decisions made, and follow-up requirements in a clear, consistent, and audit-ready manner.
• Partner with internal teams, including provider relations, contracting, claims, compliance, operations, and leadership, to support timely and accurate resolution.
• Maintain professionalism and responsiveness when addressing provider concerns and internal escalations.
• Use sound judgment to determine when issues can be resolved independently and when escalation is required.
• Adapt quickly to internal processes, systems, network rules, compliance expectations, and evolving business priorities.

Preferred Attributes

• Strong ownership and accountability.
• Collaborative and team-oriented approach.
• Ability to work independently in a remote environment.
• Sound judgment and escalation awareness.
• Adaptability and willingness to learn new systems and processes quickly.
• Regulatory and compliance awareness, including documentation standards, timely resolution expectations, and audit readiness.
• Additional Information This is a remote contract position based in the United States. Candidates must be available to start on August 10, 2026, and participate in training from 8:00 AM to 4:30 PM PST. A standard all candidates required to undergo background check is required.

Qualifications:

Qualifications

• Minimum of 2 years of experience in healthcare payer, provider relations, claims, appeals, network management, or related healthcare operations.
• Knowledge of provider contracting, credentialing, network participation, provider directories, and payer/provider relationships preferred.
• Experience researching claims issues, billing concerns, provider disputes, authorization questions, and healthcare-related escalations.
• Strong analytical and problem-solving skills, with the ability to review data, identify root causes, and recommend resolution steps.
• Comfort working across multiple healthcare systems, databases, spreadsheets, CRM tools, claims platforms, and case management tools.
• Strong written communication and documentation skills.
• High attention to detail and commitment to data accuracy.
• Ability to manage multiple priorities while meeting deadlines and service-level expectations.
• Professional, customer-service focused approach with strong follow-through and accountability.

Compensation

About Us

TalentMatch^®

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