Provider Relations Advocate

Job Summary

To support provider partnerships in the healthcare sector, the full-time remote Provider Relations Advocate will leverage managed care knowledge and claims expertise to resolve issues and enhance the provider experience within the Philadelphia Metro Area.

Key responsibilities:

• Serve as a liaison between the health plan and provider community, addressing provider issues related to claims, eligibility, and reimbursement
• Collaborate with cross-functional teams to improve operational processes and enhance provider satisfaction
• Utilize customer service skills to advocate for providers and strengthen partnerships within the network

Required qualifications:

• High school education or equivalent experience
• 3+ years of experience with a health insurance carrier, managed care organization, or payer operations team
• 1+ years of provider relations, provider services, or network management experience
• Experience resolving provider issues involving claims adjudication and reimbursement processes
• Intermediate proficiency with Microsoft Word, Excel, and PowerPoint