Provider Relations Representative

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for the contracting, credentialing, and maintenance of professional provider data to support marketing, membership and network contracting across all lines of business; building relations with the provider community is an important part of this role. Responsibilities include promoting high-quality initiatives to support data integrity; accepting ownership and leading highly specialized operational and customer support duties that require independent initiative. This role includes participating in internal provider meetings and work groups, researching problems related to provider credentialing, data and network participation. Incumbent also provides training and education to all Blue Cross contracted providers including, but not limited to hospitals, physicians, free-standing surgery centers, free standing substance abuse facilities, free standing psych facilities, VA hospitals, and all other allied professional providers. NOTE: This role is HYBRID/FLEX and requires in-office visibility three days per week, working from home the other two days. Relocation is not available; sponsorship will not be extended either now or in the future. Required Job Qualifications: • Bachelor’s degree and 3 years of work experience in managed care, OR a minimum of 5 years’ work experience in a managed care environment. • Minimum of 2 years of health care administration experience in clinical and financial settings, with direct provider communication experience. • Effective interpersonal, analytical, presentation and communication skills. • Knowledge of the health care industry. • Ability and willingness to travel within assigned areas for responsibility, including overnight stays. • Knowledge of contracts, applications, and products. • Understanding of provider reimbursement methods. • Working knowledge of claims processing systems. • Effective organizational and planning skills. • Analytical skills. • Ability to take initiative and work independently. • Demonstrated ability to meet deadlines and work well under pressure. • Clear and concise interpersonal, verbal and written communication skills. • Collaboration skills resulting in business/process improvements/changes. • PC experience and skills to include Word, Excel, PowerPoint, etc. • Facilitation, presentation and analytical skills. Preferred Job Qualifications • Experience analyzing provider performance, utilization, or operational metrics and translating findings into actionable recommendations for providers and internal stakeholders. • Experience supporting provider network initiatives, including provider onboarding, network expansion, value-based programs, or provider engagement strategies. • Demonstrated success managing complex, multi-department issue resolution efforts requiring coordination across operations, claims, network management, and other business areas. • Experience working with provider-facing reporting tools, dashboards, and data analysis to identify trends, monitor performance, and support decision-making. • Knowledge of physician practice operations, revenue cycle management, or healthcare office workflows, including an understanding of operational challenges impacting provider performance and satisfaction. • Advanced level of Excel fluency (i.e. pivot tables, data validation, handling large data sets) • Strong familiarity with claims, billing, and coding basics (CPT, ICD-10 helpful) • CRM or provider management systems knowledge • Affiliation with IAMHP (Illinois Association of Medicaid Health Plans) • Experience working with government agencies, legislative and advocacy groups NOTE: This role is HYBRID/FLEX and requires in-office visibility three days per week, working from home the other two days. Relocation is not available; sponsorship will not be extended either now or in the future. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law. Base Pay Range $63,300.00 - $114,300.00 Exact compensation may vary based on skills, experience, and location.