Senior Representative, Health Plan Provider Relations - Remote

About Our Client: The organization operates within the managed healthcare industry, focusing on health plan provider relations to support network development and adequacy. It addresses challenges related to provider engagement, compliance, and coordination within complex networks serving government-sponsored health plans such as Medicaid and Medicare. About the Opportunity: The Senior Representative, Health Plan Provider Relations manages relationships with high-priority community providers to promote satisfaction, compliance, and effective partnerships. This role serves as a key liaison between the health plan and contracted providers, providing education, resolving complex issues, and supporting network management initiatives that improve provider effectiveness and member satisfaction. Responsibilities: • Engage complex community providers to strengthen satisfaction and partnership.• Serve as the primary contact for contracted providers, including those participating in fee-for-service and pay-for-performance models.• Educate providers on policies, initiatives, and electronic tools while promoting compliance and adoption.• Resolve complex provider issues involving multiple departments and senior leadership.• Conduct regular provider site visits to assess compliance, service quality, and operational effectiveness.• Provide on-site training and maintain positive provider relationships.• Independently troubleshoot and prevent provider-plan issues.• Coordinate problem-solving meetings between providers and health plan stakeholders.• Deliver training and presentations to providers, staff, and leadership groups.• Monitor and enforce company policies to support network management objectives.• Serve as a subject matter expert on provider relations.• Train and support provider relations team members.• Travel extensively within the assigned region, including same-day and overnight travel as required. Requirements: • Minimum 3 years of experience in customer service, provider services, claims, or a related function within managed care or medical office environments.• Understanding of healthcare delivery systems, including government-sponsored health plans.• Knowledge of managed care provider compensation models across Medicaid and Medicare.• Experience delivering training and facilitating presentations.• Strong organizational skills and attention to detail.• Ability to manage multiple tasks, priorities, and deadlines.• Effective interpersonal skills for working with providers and medical office personnel.• Ability to work effectively within a cross-functional, matrixed organization.• Strong verbal and written communication skills.• Proficiency with Microsoft Office and relevant business software. Preferred Qualifications: • Experience in provider services, operations, or contract negotiations within Medicaid, Medicare, or Marketplace managed care environments.• Experience working with diverse provider types and complex provider networks. Pay Range and Compensation Package: • The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, qualifications, location, and other relevant factors. Equal Opportunity Statement:Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:TalentHop is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.