Provider Relations Representative

Job Summary 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. We are seeking a dynamic individual to join our Provider Relations team in HOUSTON, TX. The candidate will support and develop cooperative working relationships with contracted providers, facilitate provider ease of doing business, and provide training and education to all Blue Cross contracted providers. This is a hybrid/flexible role requiring in‑office presence three days a week and remote work two days. Relocation and sponsorship are not available. Responsibilities Establish and maintain strong relationships between Blue Cross and contracted providers to ensure network performance per contractual agreements. Act as the point of escalation for providers on operational, claims, financial reimbursement, policies, procedures, and contractual issues. Maintain thorough knowledge of all lines of business and Provider Relations systems (GUI, PPW, Salesforce, etc.). Assist in conducting internal and external seminars and presentations to improve HCSC–provider relationships. Lead meetings to enhance provider success using data, analytics, and presentation skills. Provide training and education to hospitals, physicians, free‑standing surgery centers, substance abuse facilities, psych facilities, VA hospitals, and other allied professional providers. Represent Provider Relations in cross‑department workflows and projects to resolve provider issues. Ensure providers are informed of changes and respond to inquiries promptly, coordinating claims resolution and payment problems. Document all provider interactions, outreach activities, issue resolution, and key relationship management details in Salesforce to support reporting and performance tracking. Track provider concerns and pain points, and participate in resolution discussions. Perform special projects and duties as assigned by leadership. Qualifications Bachelor’s Degree with 3 years of managed‑care experience *or* 5 years in a managed‑care environment. 2 years of healthcare administration experience in clinical and financial settings with direct provider communication. Strong interpersonal, analytical, presentation, and communication skills. Knowledge of the healthcare industry, payer/provider dynamics, and reimbursement methodologies. Working knowledge of claims processing systems. Organizational, planning, and initiative skills; ability to work independently. Demonstrated ability to meet deadlines and work well under pressure. PC proficiency in Word, Excel, PowerPoint, etc. Collaboration skills that drive business/process improvements. Preferred Requirements Advanced Excel fluency (pivot tables, data validation, handling large data sets). Familiarity with claims, billing, and coding basics (CPT, ICD‑10). Experience with CRM or provider management systems. Pay and Benefits Base Pay Range: $55,900.00 – $123,500.00 (exact compensation may vary based on skills, experience, and location). Benefits include health and wellness programs, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability and supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, and other incentives. 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. #J-18808-Ljbffr