[Hiring] Provider Relations Representative I @SKYGEN

Role Description

What are important things that YOU need to know about this role?

• 1-2 years of experience in customer support, provider relations, or a similar role resolving complex or escalated issues.
• Experience working with healthcare providers, insurance/claims, or high-touch client environments is a strong plus.
• Ideal candidates are confident communicators who can navigate challenging conversations, build relationships, and problem-solve across teams.

Work Location:

• Permanently remote opportunity that empowers you to stay connected, productive, and supported from day one.

Hours:

• Flexible, Monday through Friday Day Shift Hours.

What will YOU be doing for us?

• Manage provider experience and relationships once the contracting and credentialing processes are completed.
• Deliver outreach and education to newly credentialed providers regarding best practices.
• Handle routine to moderate complexity provider issues including escalated claim resolution and potential record discrepancies.
• Assist in maintaining adequate provider networks through outreach activities related to credentialing and recredentialing.
• Observe provider experience trends and make suggestions for improving the overall provider experience program.

What will YOU be working on every day?

• Conduct timely outreach to newly credentialed provider offices and review best practices.
• Conduct proactive outreach to existing provider offices to collect feedback and provide education.
• Participate in outreach campaigns designed to change provider behavior in claim and authorization submissions.
• Modify provider records in the system and observe discrepancies in information received and entered.
• Utilize the Provider-related modules in the Enterprise System to research claim, reimbursement, and utilization questions.
• Complete follow ups, OnTime tickets, and emails according to the department expectations and SLAs.
• Work with internal departments to produce, maintain, and deliver provider training references and materials.
• Resolve member access to care issues by researching providers and arranging letters of agreement with out-of-network providers.
• Act as a liaison between providers and Client Services to resolve escalated contracting and fee issues.
• Assist Client Services in researching and resolving client inquiries that involve in-depth knowledge of plan or market information.
• Offer suggestions for improving the overall provider experience based on interactions with provider offices.

Qualifications

• High school diploma or equivalent.
• 1-2 years of prior related experience in resolving escalated and challenging customer issues.
• Intermediate knowledge of Microsoft Office products including Word, Excel, and Outlook.
• Excellent written and verbal communication skills.
• Strong analytical skills.
• Ability to effectively listen and respond to internal and external customer needs.
• Ability to resolve routine to moderately complex problems.
• High degree of accuracy and good problem-solving skills.
• Ability to manage through difficult conversations.

Requirements

• 2-year degree/Bachelor’s Degree preferred.
• 1-3 years in a Provider Relations or Senior Customer Support role preferred.
• Knowledge of standard dental, medical and/or therapy terminology preferred.

Benefits

• Compensation Range: $16.51 – $24.76 per hour ($34,336-$51,504/yr).
• Compensation Midpoint: $20.63 per hour ($42,920/yr).