Provider Contracting Specialist

Group 1001 is a consumer‑centric, technology‑driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can‑do culture. Group 1001’s culture emphasizes collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Clear Spring Health is part of Group 1001, a customer‑centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well‑being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia, South Carolina and offers Medicare Prescription Drug Plans in 42 states plus DC.

The Provider Contracting Specialist supports the development, maintenance, and performance of Clear Spring Health’s Medicare Advantage provider network. This role is responsible for drafting, negotiating, and maintaining provider contracts, ensuring compliance with CMS and state regulatory requirements, and supporting provider relations to achieve high levels of provider satisfaction and network adequacy. The ideal candidate is detail‑oriented, collaborative, and driven by our mission to simplify health to enrich lives.

• Draft, negotiate, and execute provider contracts and amendments for physicians, hospitals, and ancillary providers.
• Maintain a complete and accurate record of all executed agreements and associated rate schedules.
• Ensure contract terms comply with CMS, state, and organizational requirements, including credentialing, termination, and delegation standards.
• Support contract rate analysis, financial modeling, and payment term reviews in collaboration with Finance and Claims teams.
• Develop and negotiate complex contract arrangements including contracts with IPAs, CINs, large health systems, and value‑based contracts.

• Assist in network expansion to meet CMS network adequacy standards by identifying and recruiting targeted specialties and geographic areas.
• Maintain and update provider demographic data and contract details within network management systems.
• Coordinate closely with Credentialing, Provider Data Management, and Provider Relations to ensure seamless provider onboarding.

• Support regulatory audits, pre‑delegation assessments, and ongoing oversight activities.
• Track contract renewals, expirations, and performance guarantees.
• Ensure all provider contracts align with current CMS guidance, state regulations, and Clear Spring Health policies.
• Partner with internal stakeholders to address escalations related to provider payment, network participation, and directory accuracy.

• Bachelor’s degree in Business Administration, Healthcare Management, or related field required.
• Minimum 3–5 years of experience in provider contracting, network management, or managed care operations (Medicare Advantage experience preferred).
• Strong understanding of CMS MA network adequacy, contracting, and compliance requirements.
• Proficiency in Microsoft Excel, Word, and contract management systems.
• Exceptional attention to detail, organizational skills, and ability to manage multiple priorities in a fast‑paced environment.
• Strong communication, negotiation, and relationship‑building skills.

Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay for this position ranges from $100,000/year in our lowest geographic market up to $140,000/year in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job‑related knowledge, skills, and experience.

Employees who meet benefit eligibility guidelines and work 30 hours or more weekly have the ability to enroll in Group 1001’s benefits package. Employees (and their families) are eligible to participate in the Company’s comprehensive health, dental, and vision insurance plan options. Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long‑Term Disability. All employees (regardless of hours worked) have immediate access to the Company’s Employee Assistance Program and wellness programs—no enrollment is required.

Employees may also participate in the Company’s 401(k) plan, with matching contributions by the Company.