Network Internal Representative

Community Health Network of Connecticut, Inc; Wallingford (CT); On-site; USD 58,457,000 - 73,104,000; Full time

Job summary

Community Health Network of Connecticut, Inc. in Wallingford, CT invites applications for a Network Internal Representative. This regular full-time role supports Provider Engagement Services, handling data entry, provider directory updates, and outreach within CMAP networks.

Responsibilities include enrollment activities, grievance review, and coordination using CACTUS/sProvider and CRM systems while communicating with providers by phone and email to ensure timely, accurate provider information.

Qualifications

• 5 years Medicaid or related administrative experience.
• At least 3 years handling customers/providers via phone or email.
• Knowledge of Connecticut health care delivery system.
• Proficient with Microsoft Office suite (Word, Excel, Outlook).
• Familiarity with CACTUS/sProvider and CRM tools.

Responsibilities

• Verify, analyze, and maintain provider/hospital data for directories.
• Telephonic and email recruitment of in-state/out-of-state providers.
• Recruit OPR providers and CMAP entities for re-enrollment.
• Monitor provider-related grievances and respond in a timely manner.
• Input data into CRM from tasks and grievances.
• Assist PCP attribution reports with Population Health initiatives.

Skills

Data entry

CRM

CACTUS/sProvider

Phone & email outreach

Microsoft Office

Education

High school diploma or GED

Secondary schooling or vocational training

College level degree preferred

Tools

CACTUS/sProvider

CRM

Interchange

Outlook

PowerPoint

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Network Internal Representative

Regular Full Time High Wallingford, CT, US

Salary Range: $20.42 To $25.53 Hourly

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Network Internal Representative to join our team.

Primary Responsibilities:

• Under the supervision of the Manager, Provider Engagement Services (PES), performs data entry and systems maintenance for provider/hospital files in CACTUS/sProvider data management system.
• The Internal Representatives basic function is to support the External PES Representatives while they are onsite at Connecticut Medical Assistance Program (CMAP) network provider locations.
• Network Internal Representatives also update and maintain provider/hospital files in CACTUS/sProvider for the member/provider on‑line directory.
• Provide direct support in Member/Provider Financial Grievance resolution by reviewing member eligibility and claims.
• Outreach CMAP providers when members are billed and follow up with members via email on grievance resolution.
• Performs other duties as assigned by the VP of Population Health and/or Manager of PES.

Tasks Performed:

• Verifies, analyzes, and maintains all provider/hospital data in support of member/provider directory for assigned region(s).
• Daily duties include telephonic and email recruitment of instate and out-of-state providers through tasks sent by the Member Engagement Services Call Center.
• Performs telephonic and email recruitment of all Ordering, Prescribing and Referring (OPR) providers sent by DSS.
• Telephonic and email recruitment of Connecticut Medical Assistance Providers (CMAP) who are to re‑enroll within 60‑days of DSS termination date.
• Telephonic and email outreach of CMAP providers that are terminated from the network to reenroll and track termination reasons.
• Monitor CRM for provider-related financial grievances and inquiries and provide a timely response if needed.
• Input data into CRM from Tasks and Grievances.
• Aid in the identification of Primary Care Providers (PCP) through PCP attribution reports and collaborating with the Quality Management Person-Centered Medical home team.

Essential Functions:

• May be called upon to perform problem resolution and company operating policy guidance to hospital, physician, and other designated providers in the CMAP network.
• Must be able to adapt to a fast paced, changing work environment.
• The ability to update and query in CACTUS/sProvider is an important part of the job responsibility.

Desired Education: Secondary schooling or vocational training

Desired Degree: High school diploma or GED required; College level degree preferred

Desired Major: General studies; business courses

Desired Job Experience:5 years related experience in Medicaid and associated administrative practices; at least 3 years of demonstrated proficiency handling customers and/or providers via telephone or electronic email.

Other Qualifications: Knowledge of the Connecticut health care delivery system. Knowledge of Medicaid Program and demonstrated skills performing administrative practices (purchase vouchers, scheduling meetings) Knowledge and ability to perform and learn various software programs. Proficient with Microsoft Office suite including Word, Excel (including basic formulas, sorting, filtering, etc.), Outlook, PowerPoint, CRM, Interchange, and CACTUS/sProvider.

We are dedicated to having a workplace where everyone feels valued, respected, and empowered to succeed. We embrace a wide range of perspectives and backgrounds, ensuring fair treatment and opportunities for all employees. We value our team’s rich array of experiences and viewpoints, which contribute to our innovative and collaborative environment.

We are committed to providing an inclusive and accessible interview process. If you require a reasonable accommodation for your interview due to a disability. Please contact us in advance if you need an accommodation.

Attachments (1)

Network Internal Representative (CS52) 09.24.2026.pdf