The posting
NationsBenefits is recognized as one of the fastest-growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members.
Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.
Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members.
We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India.
Role:
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
Requirements:
• 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
Success Measures:
• Escalation resolution within standard turnaround times
• Provider satisfaction
• Reduction in repeat issues by category
• Accuracy and completeness of escalation documentation
Why Join NationsBenefits?
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.
