Health Care Service Corporation (HCSC) is the United States' largest customer-owned health insurer. HCSC is a desirable, diverse employer and has been named one
Provider Relations Representative
Location
Texas
Posted
16 days ago
Salary
$55.9K - $123.5K / year
Seniority
Senior
No structured requirement data.
Job Description
Provider Relations Representative
Health Care Service Corporation - HCSC
Title: Provider Relations Representative Location: Houston Job Description: Flex time type Full time job requisition id R0051042 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 BASIC FUNCTION HCSC is looking for a dynamic individual to join its Provider Relations team in HOUSTON TX! This position is responsible for providing support, as well as developing and maintaining cooperative working relationships with contracted providers. Will also be responsible for facilitating and enhancing provider ease of doing business with HCSC which includes issue tracking and resolution, educating, training, identifying trends and evaluating providers to ensure that all contractual and financial requirements are adhered to and performed. 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. This role is HYBRID/FLEX and requires in-office visibility three days per week, working from home the other two days. NOTE: relocation is not available, sponsorship will not be extended either now or in the future. JOB REQUIREMENTS/QUALIFICATIONS - Bachelor’s Degree and three (3) years of work experience in managed care OR a minimum of five (5) years work experience in a managed care environment. - Two (2) years of healthcare administration experience in clinical and financial settings, with direct provider communication experience. - Effective interpersonal, analytical, presentation and communication skills. - Knowledge of the healthcare industry, healthcare systems and payer/provider dynamics. - Ability and willingness to travel within assigned areas for responsibility, including overnight stays. - Strong comprehension of contracts, applications, and products. - Understanding of provider reimbursement methodologies and claims. - Working knowledge of claims processing systems. - Effective organizational and planning skills with the 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 proficiency and skills to include Word, Excel, PowerPoint, etc. - Strong facilitation, presentation and analytical skills. PREFERRED REQUIREMENTS/QUALIFICATIONS - 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. ~ KEY FUNCTIONALITY ~ - Establishes and maintains relationships between Blue Cross and contracted providers to promote and ensure that BCBS networks are performing per the contracted agreement (e.g. compliance, PEAQ, etc.). - Act as point of escalation for providers regarding aspects of their relationship with HCSC with possible topics to include operations, claims, financial reimbursement, policies, procedures, and contractual issues. - Maintains a thorough level of knowledge for all lines of business to ensure provider contract compliance and performs investigative research upon the request of providers regarding the intricate and detailed information for all lines of business. - Maintains a thorough level of knowledge regarding all Provider Relations systems (e.g.: GUI, PPW, Salesforce, etc.) - Assists in conducting internal and external seminars and presentations as needed for the improvement of HCSC / provider relationships. - Lead internal and external meetings to assure and enhance provider success (e.g.: PowerPoint decks, Excel, analytics, presentation skills). - 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. - Represent Provider Relations in cross-department workflows and projects and ensure appropriate provider services, including working across departments to resolve issues. - Ensure assigned providers are informed when changes occur and respond to provider inquiries in an effective and timely manner and coordinate claims resolution to payment problems. - Communicate and interact effectively and professionally with co-workers, management, customers, etc. - Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. - Maintain complete confidentiality of company business. - Ensure all expenditures comply with corporate and divisional expense guidelines. - Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. - Maintain accurate and timely documentation within Salesforce, ensuring all provider interactions, outreach activities, issue resolution, and key relationship management details are consistently recorded and updated to support business operations, reporting, and performance tracking. - Provide project support as needed, including tracking milestones, managing timelines, coordinating cross-functional activities, and contributing to project documentation and status updates. - Responsible for maintaining an up-to-date tracker of provider concerns and pain points and participate in discussions around resolutions. - Other duties as assigned by leadership. #LI-TP1 #LI-HYBRID 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. 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. Base Pay Range $55,900.00 - $123,500.00 Exact compensation may vary based on skills, experience, and location.
Related Guides
Related Categories
Related Job Pages
More Call Center Representative Jobs
Role Description Be a part of a team who "cares for the least of these," and building fulfilling futures for you and others. Rock House is a family-owned business that has been a leader in residential, foster, and in-home support and care for persons with special needs. If you are an RN who wants a fun job working daytime hours, physically non-demanding work, and a place where you can build long-term relationships with patients, Rock House is the place for you! - Monitoring ongoing medical needs of residents in group home settings. - Performing nursing assessments. - Developing and implementing nursing care plans and other clinical documentation. - Delegation of medication and training regarding medication needs. Benefits - Medical/Dental/Vision Insurance - Life Insurance - Vacation - Paid Holidays - 401k Retirement Plan - Referral Program
Title: LAN Gaming Associate - Boeing Center at Tech Port locations San Antonio, TX time type Part time job requisition id R100122917 LAN Gaming Associate POSITION: LAN Gaming Associate DEPARTMENT: Esports and LAN Gaming REPORTS TO: LAN Center Manager & LAN Center Supervisor FLSA STATUS: Part-time Hourly, Non-Exempt SUMMARY In this role, you will be responsible for operating and maintaining a 50 PC LAN Center. Standard tasks will include performing cashless sales, greeting and servicing customer needs, troubleshooting PC’s, updating games, and thorough cleaning of desks/chairs/peripherals. Additional tasks may be assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES - Operate the LAN Gaming Center; to include technology troubleshooting, daily operations, and customer interactions - Work with the Esports and LAN Gaming department to help setup and run esports related events and tournaments - Must be able to work cashless sales terminal - Additional tasks may be assigned Qualifications - Strategic and critical thinker who is dynamic, forward-thinking, analytical, and extremely well organized - Excellent service & communication skills - Must pass background and credit check - Must be 18 years old - Must be TABC certified EDUCATION AND/OR EXPERIENCE - Customer service experience required - Knowledge of PC hardware required - High school diploma or general education degree (GED) preferred - Experience in running gaming related events preferred - Experience in troubleshooting PC’s preferred SKILLS AND ABILITIES - Ability to work nights, weekends and holidays - Ability to work in a team - Positive attitude and neat appearance - English preferred as primary language, but not required - Knowledge of games and gaming platforms, and able to assist users with any issues - Ability to keep 50+ systems operating while maintaining proper cleanliness - Additional tasks may be assigned PHYSICAL DEMANDS - Ability to stand and walk for entire length of shift - Ability to lift and carry supplies and equipment up to 60 pounds and place items on high and low shelves - Ability to get under desks and counters to adjust wiring/move equipment - Occasionally required to reach up to 6-7 feet, twist at waist, bending and squatting - While performing the duties of this job, the employee is regularly required to move around the facility; to stand for long hours during events; talk and hear. This position may require work inside or outside of the building, as needed by events. - The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Title: Rivers Crossing Part Time PM Financial Service Representative Location: 1461 South River Road, St. George, UT 84790, USA - 16.00 per hour $16.00 + DOE - Hourly - Part Time - Health, dental, and vision plans; 401k matching and retirement plans; paid vacation/holidays, tuition reimbursement and more! Job Description: Join Our Team as a Part-Time Member Service Representative (Teller) for Our Rivers Crossing Branch! Are you passionate about developing meaningful relationships and helping others achieve their financial goals? Do you thrive in a dynamic relationship-focused environment that emphasizes building connections, fostering, professional growth, and teamwork? If you're ready to make an impact with a respected financial institution that prioritizes its members and employees, this is your chance to shine! At Cyprus Credit Union, our team is the heart of everything we do. We're dedicated to creating a culture where every employee feels valued, supported, and inspired to succeed. That's why we offer: - Competitive pay with opportunities for bonuses and incentives. - A bilingual pay increase for English/Spanish speakers. - Comprehensive benefits, including health, dental, vision, life insurance, and more. - Retirement savings plans like 401k. - Generous PTO from day one, with additional time off for your birthday and volunteer work. - Tuition reimbursement for ongoing education and professional development. - A vibrant, inclusive environment focused on community impact and sustainability. It's no surprise we've been recognized as one of the BEST credit unions to work for from 2020 to 2025! What Makes Working at Cyprus Special? As a Member Service Representative, you're more than just a teller-you're a trusted partner in our members' financial journeys. You'll build relationships, educate members about our products and services, and ensure every interaction leaves them feeling valued and supported. Through our innovative "career pathing" programs, we'll help you grow your skills, advance your career, and make an impact. What You'll Do: Be a Financial Guide: Engage members in meaningful conversations to uncover their financial goals, challenges, and opportunities. Promote Solutions: Share our diverse suite of products and services, such as savings accounts, loans, and investment options, tailored to help members achieve their unique financial aspirations. Educate and Empower: Help members understand the value of our offerings and how they can make informed decisions for a secure financial future. Drive Member Success: Offer proactive solutions to address immediate needs and anticipate future opportunities, creating a pathway for long-term financial well-being. Execute Transactions: Perform deposits, withdrawals, transfers, and other transactions with care and accuracy, ensuring a seamless experience. Be a Trusted Partner: Build and nurture strong relationships with members, becoming their go-to resource for financial advice and support. Your Skills & Experience: Education: A high school diploma or equivalent (or work release papers). Service Mindset: You excel at connecting with people, understanding their needs, and presenting tailored solutions. Previous experience in customer service or sales is a plus, highlighting your ability to deliver exceptional results and create value for members. Relationship Builder: You have a natural ability to establish trust, build lasting relationships, and genuinely care about helping members achieve their financial goals. Persuasive Communicator: Strong communication skills that allow you to clearly explain products and services, inspire confidence, and motivate members to take action toward their financial success. Empathetic Listener: You know how to ask the right questions, actively listen, and respond with solutions that resonate with each member's unique situation. Team Player with a Positive Attitude: Enthusiasm for collaborating with colleagues and contributing to a supportive, dynamic team environment. Passion for Helping Others: A genuine desire to guide members toward financial solutions that enrich their lives. Your Schedule: This part-time role offers a set schedule: Monday-Friday, 1:30 PM - 6:15 PM, with some Saturdays required from 8:45 AM - 2:15 PM. Enjoy your evenings and Sundays free to recharge! Why Wait? Your Future Starts Here! At Cyprus Credit Union, we believe in fostering an environment where both our members and employees can thrive. If you're ready to be part of a team that celebrates success, encourages growth, and makes a difference in the community, apply today!
Call Center Remote Customer Service Representative
GetInsuredGetInsured is a health insurance broker that partners with healthcare providers to deliver “the nation’s easiest way to shop for health insurance.” A lice
Title: Call Center Remote Customer Service Representative Location: New Mexico - Santa Fe, CA 94043 Fully Remote Overview Salary Range $17.00 - $19.00 Hourly Position Type Full Time Category Customer Service Job Description: It's truly an exciting time to be a part of VImo! We are hiring Remote Customer Service Representatives to join our elite teams. Despite everything we are facing in our communities and our country right now, Vimo is coming together as a team, adapting, growing, and hiring. At Vimo there are many opportunities to grow, and we hope to appeal to reliable, dedicated, and self-driven individuals to join us. We are committed to building each other up and infusing a motivating and positive work environment, despite working remotely. Our vision has always been to make finding and enrolling in health insurance simple, this is more important now than ever before. As a Remote Customer Service Representative, you'll be a part of delivering an amazing customer experience and help unveil the mystery of finding and enrolling in health insurance. Vimo currently has the largest state-based marketplace footprint, and our consumer-friendly interface and decision support tools empower millions of consumers across the country to make better health plan decisions. Vimo builds and operates award-winning cloud-based enrollment tools that serve state-based exchanges, brokers, insurers, and consumers. In addition to eligibility determination, plan selection, and enrollment technology for state agencies, the company delivers innovative agent marketing and call center tools and services. Full-time/Seasonal · $17.00/hr. plus performance incentives · $19.00/hr. Spanish Bilingual, plus performance incentives Requirements - 18 years of age or older - Complete Background check and drug test within 3 days - Dedicated, private, and secure workspace - Personal device with functioning camera required for the Training Period - Committed to full attendance for paid 3-week Training period - Minimum Internet Speed of 35 mb/s with ethernet - Cable/Fiber Broadband Internet with a hard-wired ethernet connection is required - NOT compatible with Mobile Internet Service Providers and/or Satellite. - NOT compatible with Wi-Fi internet access or Wi-Fi adapter/extenders (For example, T-Mobile is not compatible with our internal systems) - Qualifications Essential Responsibilities - Inbound/Outbound Calls - Deliver the highest level of customer service experience consistently - Manage customer accounts and provide technical support - Application Data Entry - Online chat inquiries as assigned - Interpret and follow defined procedures and policies - Creative problem-solving skills - Flexibility and adaptability to changing projects and updates - Time and task management (multitasking and task prioritization) - Extensive self-study, training, and testing are required; eligibility to proceed through training and certifications is dependent upon passing required exams - Adhere to regulated guidelines for communications via all channels Qualifications - Moderate to Advanced computer skills - High level of comfort learning new technology - High level of professionalism - Excellent verbal and written communication skills - Comfortable working from home - Self-motivated and success-driven What We Offer - Paid Training - Full-Time, Seasonal role - Performance and attendance-based incentives, in addition to the base pay - The convenience of working from home - Collaborative and supportive team environment - 401K Match - Individual Coverage HRA (ICHRA) - Paid time off (PTO) Preferred Experience (not required) - Previous experience in customer support or technical support role - Previous experience with Group and/or Individual health insurance, or the Affordable Care Act - Previous experience in a Call Center - Familiarity with CRM systems and practices - Spanish Bilingual, a plus
