Provider Relations Representative

Health Care Service; Springfield (IL); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Flex role

3 days in office

2 days WFH

Hybrid work model

Job summary

Health Care Service Corporation (HCSC) seeks a Provider Relations professional to develop and maintain cooperative relationships with contracted providers. You will resolve issues, educate providers, and ensure compliance with contractual and financial requirements across a national scope.

The role emphasizes strong service and operational excellence, communication, and travel as needed to support provider networks and respond to inquiries about medical insurance and claims processes.

Qualifications

• Bachelor's degree with 3 years managed care experience, or 5 years in a managed care environment.
• 2+ years in health care administration with direct provider communication.
• Knowledge of Medicaid and Medicare business processes.
• Strong interpersonal, analytical, presentation and communication skills.
• Willingness to travel, including overnight stays.

Responsibilities

• Provide support and develop cooperative relationships with contracted providers.
• Facilitate and enhance providers' ease of doing business with HCSC.
• Track and resolve issues, educate and train providers, identify trends.
• Evaluate providers to ensure contractual and financial requirements are met.
• Support provider inquiries on medical insurance and claims processes nationally.

Skills

Interpersonal skills

Analytical skills

Presentation skills

Communication skills

Organizational skills

Willingness to travel

Education

Bachelor's degree

Tools

MS Word

Excel

PowerPoint

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for providing support, as well as developing and maintaining cooperative working relationships with contracted providers. Responsible for facilitating and enhancing provider's ease of doing business with HCSC. This includes issue tracking and resolution, education, training, identifying trends and evaluating providers to ensure that all contractual and financial requirements are adhered to and performed. Supports providers on medical insurance and claims-related inquiries, leverages knowledge of Medicaid and Medicare business processes to resolve issues and provide education, and addresses provider requests across a national scope while promoting consistent service and operational excellence.

Required Job Qualifications

• Bachelor's degree AND 3 years of work experience in managed care, OR a minimum of 5 years' work experience in a managed care environment.
• Minimum of 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 for responsibility, 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.
• Analytical skills.
• Ability to take initiative and work independently.
• Demonstrated ability to meet deadlines and work well under pressure.
• Clear and concise interpersonal, verbal and written communication skills.
• Collaboration skills resulting in business/process improvements/changes.
• PC experience and skills to include Word, Excel, PowerPoint, etc.
• Facilitation, presentation and analytical skills.

Preferred Job Qualifications

• 3 years of experience supporting medical insurance operations, claims handling, and provider issue resolution.
• Demonstrated knowledge of Medicaid and Medicare business processes, including provider education and operational support.
• 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 with the ability to educate providers on policies, processes, and business requirements.

Sponsorship is not available.

This is a Flex role that requires 3 days in office and 2 days WFH.

#LI-Hybrid #LI-KW1 #INAK

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful comp