Provider Relations Representative

Position Summary:

Responsible for the education and servicing of assigned provider groups regarding all aspects of the Plan and its subsidiaries. Responsible for assisting in the development of policy, procedures and educational materials for use with all Provider Programs and for the development of benchmarks to measure performance against the Plan’s goals. Establishes and maintains effective relationships with key physicians and office staff of contracted medical delivery entities (i.e. provider offices, specialists, etc.). Responsible for contracting of PCP’s, Specialists, and Ancillary providers in their defined servicing area. Responsible for claims research and resolution. All duties are to be carried out in collaboration with the contracting staff and other key senior staff as appropriate.

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