Provider Relations Representative

Health Care Service Corporation•Chicago, IL

3d•$63,300 - $114,300•Hybrid

About The Position

This position supports contracted providers and develops and maintains cooperative working relationships with them. The representative facilitates providers’ ease of doing business with HCSC through issue tracking and resolution, education, training, trend identification, and evaluation to ensure contractual and financial requirements are met. The role responds to medical insurance and claims-related inquiries, applies knowledge of Medicaid and Medicare business processes to resolve issues and educate providers, and addresses provider requests across a national scope while promoting consistent service and operational excellence. This is a flex role requiring three days per week in the Chicago office and two days working from home. Travel within assigned areas, including overnight stays, is required. Sponsorship is not available.

Requirements

Bachelor’s degree and 3 years of work experience in managed care, or a minimum of 5 years of work experience in a managed care environment.
At least 2 years of health care administration experience in clinical and financial settings, with direct provider communication experience.
Demonstrated knowledge of Medicaid and Medicare business processes, including provider education and operational support.
Effective interpersonal, analytical, presentation, and communication skills.
Knowledge of the health care industry.
Ability and willingness to travel within assigned areas, including overnight stays.
Knowledge of contracts, applications, and products.
Understanding of provider reimbursement methods.
Working knowledge of claims processing systems.
Effective organizational and planning skills.
Ability to take initiative and work independently.
Ability to meet deadlines and work well under pressure.
Clear and concise interpersonal, verbal, and written communication skills.
Collaboration skills resulting in business or process improvements and changes.
PC experience and skills, including Word, Excel, and PowerPoint.
Sponsorship is not available.

Nice To Haves

3 years of experience supporting medical insurance operations, claims handling, and provider issue resolution.
Experience researching, tracking, and resolving provider inquiries while ensuring a high level of service and responsiveness.
Proven ability to develop and maintain strong relationships with contracted providers and key stakeholders.
Experience identifying trends, resolving escalated issues, and recommending process improvements.
Knowledge of contractual and financial requirements related to provider network operations.
Experience supporting provider requests across multiple markets or a national provider network environment.
Strong communication and training skills, including the ability to educate providers on policies, processes, and business requirements.

Responsibilities

Support contracted providers and develop and maintain cooperative working relationships with them.
Facilitate providers’ ease of doing business with HCSC through issue tracking and resolution, education, and training.
Identify trends and evaluate providers to ensure contractual and financial requirements are adhered to and performed.
Support providers with medical insurance and claims-related inquiries.
Use knowledge of Medicaid and Medicare business processes to resolve issues and provide education.
Address provider requests across a national scope while promoting consistent service and operational excellence.
Research, track, and resolve provider inquiries while ensuring a high level of service and responsiveness.
Identify trends, resolve escalated issues, and recommend process improvements.
Travel within assigned areas, including overnight stays.