Network Relations Consult Sr (US)

Elevance Health • Gilbert, MN

148d • $65,360 - $118,680

About The Position

The Network Relations Consult Sr is responsible for developing and maintaining positive provider relationships with the provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues. Serving as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution.

Requirements

• Requires a Bachelor's degree and a minimum of 5 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
• Travels to worksite and other locations as necessary.

Responsibilities

• May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
• Functions as a high level technical resource to resolve or facilitate complex provider issues.
• Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.
• Provide assistance regarding education, contract questions and non-routine claim issues.
• Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
• Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
• Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
• Tracks and conduct provider refresher training.
• Researches issues that may impact future provider negotiations or jeopardize network retention.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees