Senior Provider Relations Advocate - Remote

Improve the lives of others while Caring. Connecting. Growing together.

Job Description
- Senior Provider Relations Advocate
- Remote (2388098)

Senior Provider Relations Advocate
- Remote - 2388098

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Senior Provider Relations Advocate serves as a subject matter expert responsible for managing complex provider, claims, payment, authorization, access, data, and operational escalations. This role acts as a liaison between providers, internal business partners, payer organizations, and leadership to ensure timely resolution of issues while improving the overall provider experience.

Working with minimal supervision, the Senior Provider Relations Advocate independently researches, analyzes, and resolves complex and often ambiguous issues that require cross-functional collaboration. This position plays a critical role in identifying root causes, driving accountability, escalating barriers, and recommending process improvements that reduce operational friction and improve resolution outcomes.

The ideal candidate possesses solid analytical, problem-solving, and relationship-management skills. A claims background is solidly preferred, as a significant portion of the role involves researching and resolving escalated claims, payment, and reimbursement issues.

The person hired into this role will need to be able to work Central Time Zone hours, generally 8am - 5pm, with some flexibility in schedule allowed.

You’ll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

• Manage end-to-end resolution of complex provider and operational escalations
• Assess issue severity, business impact, urgency, and required actions
• Investigate and resolve escalated issues involving:
  • Claims and payment discrepancies
  • Prior authorization concerns
  • Provider and member data issues
  • Eligibility concerns
  • Provider incentive payment disputes
  • Access and technology-related issues
  • Operational and service-related concerns
• Facilitate timely resolution through effective coordination across multiple business areas
• Maintain ownership and accountability throughout the issue lifecycle from intake through closure
• Claims and Payment Resolution
  • Research complex claims and payment inquiries utilizing multiple systems and data sources
  • Analyze claim adjudication outcomes, payment methodologies, remittance information, and provider reimbursement concerns
  • Identify root causes impacting claims processing and payment accuracy
  • Partner with claims operations, payment integrity, health plans, network management, and other stakeholders to resolve issues
  • Educate providers and internal partners on claims processes, policies, and resolution pathways
• Research and Root Cause Analysis
  • Conduct detailed investigations into complex operational and provider issues
  • Analyze trends, recurring problems, and systemic barriers affecting provider satisfaction and operational performance
  • Identify opportunities for sustainable corrective actions
  • Develop recommendations that improve processes, workflows, and customer experience
  • Translate complex findings into actionable solutions for stakeholders and leadership
• Provider Advocacy and Relationship Management
  • Serve as a trusted advocate for providers while balancing organizational policies and business objectives
  • Assess and interpret provider needs and requirements
  • Communicate complex information in a clear, professional, and customer-focused manner
  • Build and maintain positive relationships with providers and internal stakeholders
• Cross-functional…