Provider Relations Specialist — Remote (IL)

Humana; United States; Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Bonus potential

Medical benefits

401(k) retirement plan

Job summary

Humana is seeking a Provider Relations Representative to manage day‑to‑day provider relationships for Humana’s Illinois networks, including onboarding, training, and issue resolution. The role emphasizes collaboration with enterprise teams to ensure an exceptional provider experience and network retention.

Based in Illinois with travel, the position focuses on building strong provider networks, conducting trainings, and communicating policy updates while supporting regulatory requirements and

Qualifications

• 2+ years health care or managed care experience with providers (e.g., provider relations, claims education).
• Experience with Illinois Medicaid.
• Experience with Behavioral Health providers and Community Mental Health Centers.

Responsibilities

• Serve as primary relationship manager with assigned providers to ensure positive provider experience with Humana’s Dual Fully Integrated and Healthy Horizon plan of Illinois and promote network retention.
• Meet regularly with providers to conduct training and education, including annual trainings and policy updates.
• Support onboarding for new providers, including hosting orientation sessions.
• Respond to provider inquiries and support prompt issue resolution with internal teams (claims, authorizations, referrals).
• Create provider trainings based on feedback and trends; educate on materials locations (Orientation, Provider Manual, Newsletter).
• Convene regular provider meetings, organize agendas/materials/minutes with cross‑functional teams.
• Educate on processes including claims submissions, recoupments, authorizations, referrals, medical records and Availity.
• Communicate updates on Humana policies and Cardinal Care updates; coordinate regional provider townhalls/trainings.
• Attend Network Meetings/Conferences; ensure compliance with Virginia managed care requirements.

Skills

Relationship management

Provider relations

Training & education

Health plan operations

Job description

Humana is seeking a Provider Relations Representative to manage day‑to‑day provider relationships for Humana’s Illinois networks, including onboarding, training, and issue resolution. The role emphasizes collaboration with enterprise teams to ensure an exceptional provider experience and network retention.

Based in Illinois with travel, the position focuses on building strong provider networks, conducting trainings, and communicating policy updates while supporting regulatory requirements and