Provider Network Relationship Specialist II

RiseMe; Minnetonka (MN); On-site; USD 51,000 - 76,000; Full time

Job summary

Medica in Minnesota is seeking a Provider Network Relationship Specialist II to strengthen provider and vendor partnerships, support member access, and ensure service reliability. You will serve as the primary contact for assigned providers, coordinate program rollouts, and surface trends to improve performance.

This office-based role requires a bachelor’s degree and 3+ years of experience, with preferred background in call center or healthcare operations.

Qualifications

• Bachelor's degree or equivalent experience in related field.
• 3+ years of work experience beyond degree.
• Experience in call center or customer service environment preferred.
• Experience in provider relations, claims, billing, or insurance operations preferred.
• Familiarity with provider networks and healthcare regulations.

Responsibilities

• Serve as the primary point of contact for assigned providers or vendors to foster trust and partnership.
• Coordinate program rollouts, policy updates, and operational changes to support provider readiness.
• Gather provider or vendor feedback and surface trends to improve experience and performance.
• Maintain regular touchpoints to reinforce expectations and assist mutual goals.
• Manage escalated issues and coordinate resolution with internal partners.

Skills

Strong communication

Interpersonal skills

Team oriented

Multitasking

Education

Bachelor's degree or equivalent experience

Tools

Claims systems

Job description

Key Accountabilities

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Provider Network Relationship Specialist II strengthens Medica’s network by developing and maintaining effective relationships with assigned providers or vendors, supporting member access, affordability, and service reliability. The role supports network adequacy and readiness by focusing on issue resolution, coordinating change communication and enabling smooth onboarding and ongoing engagement. It advances provider or vendor experience and operational consistency through clear communication, coordinated issue resolution, and accurate provider or vendor data. The Specialist operates with limited supervision and applies developing decision-making authority, with some creativity and latitude, to support team and organizational objectives. Performs other duties as assigned.

Provider or Vendor Relationship Management & Engagement

• Serve as the primary point of contact for assigned providers or vendors, fostering trust, responsiveness, and partnership.
• Coordinate communications on program rollouts, policy updates, and operational changes to support provider readiness.
• Gather provider or vendor feedback and surface trends to internal partners to improve experience and performance.
• Maintain regular touchpoints to reinforce expectations, clarify processes, and support mutual goals.
• Deliver ongoing education regarding operational changes and workflows.
  

Network Participation Evaluation & Panel Readiness

• Intake provider or vendor requests for inclusion in assigned territories and triage to ensure the appropriate network needs and adequacy considerations are achieved.
• Recommend participation decisions and document rationale consistent with policies and standards.
• Monitor inclusion decisions to ensure network readiness and member access.

Issue Resolution & Appeals Coordination

• Manage escalated provider or vendor issues by coordinating with internal partners to research, resolve, and communicate outcomes.
• Support provider or vendor appeals by collecting facts, organizing documentation, and facilitating timely responses.
• Identify root causes of recurring issues and recommend process or communication improvements.
• Maintain accurate case records to inform trend analysis and continuous improvement.

Provider or Vendor Data Integrity & Operational Coordination

• Validate accurate provider or vendor demographic and participation data across systems for issue resolution.
• Escalate discrepancies and coordinate corrections with data management and operational teams for issue resolution.

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 3+ years of work experience beyond degree

Preferred Qualifications

• Experience in a call center or customer service environment.
• Experience in provider relations, claims, billing, or insurance operations.
• Familiarity with provider networks and healthcare regulations.
• Knowledge of healthcare provider contracting and credentialing processes.
• Proficiency in handling provider inquiries through various channels.
• Strong communication and interpersonal skills; team oriented.
• Ability to navigate multiple claims systems and understand member contracts.
• Ability to manage multiple priorities and work independently.

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near the Minnetonka, MN office locations.

The full salary grade for this position is $50,800 - $87,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $50,800 - $76,125. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US:

Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.