Provider Network Relations Specialist — Remote

US Family Health Plan- A TRICARE Prime option; New York (NY); Hybrid; USD 70,000 - 75,000; Full time

Benefits offered by this job

Medical, Vision & Dental coverage

401(k) retirement plan with employer-m

Tuition reimbursement

Commuter benefits

Job summary

US Family Health Plan- A TRICARE Prime option in New York, NY seeks a Provider Network Specialist to build strong provider relations, educate on TRICARE policies, and support network performance. The role interfaces with multiple internal teams to ensure smooth operations and regulatory compliance.

The candidate will onboard new providers, monitor network adequacy, and analyze performance metrics to drive improvements.

Qualifications

• Associate’s degree or equivalent experience required.
• 5-8 years’ experience in health insurance, provider network or provider contracting.
• Access to personal vehicle and a valid driver’s license.
• Ability to lift 20 pounds.

Responsibilities

• Educate providers on Plan policies, procedures, billing guidelines and TRICARE requirements.
• Support onboarding and orientation of newly contracted providers and ongoing training on Plan policies and TRICARE requirements.
• Monitor network adequacy and respond to gaps or access issues.
• Collaborate with internal departments to resolve provider issues and ensure beneficiary needs.
• Assist providers with claim resolution, credentialing inquiries, contract interpretation and system navigation.

Skills

Interpersonal skills

Organizational skills

Presentation skills

Verbal and written communication

Data entry

Time management

Education

High School Diploma

Associate’s Degree preferred

Tools

Microsoft Office

Access

Salesforce

Job description

US Family Health Plan- A TRICARE Prime option in New York, NY seeks a Provider Network Specialist to build strong provider relations, educate on TRICARE policies, and support network performance. The role interfaces with multiple internal teams to ensure smooth operations and regulatory compliance.

The candidate will onboard new providers, monitor network adequacy, and analyze performance metrics to drive improvements.