Assist and educate members, employer groups, providers, colleagues, and/or elite agents of health plan benefits with accessing services, facilitating and resolving complex problems, understanding claims, billing and coding, along with other non-routine questions.
Responsibilities
Demonstrates high competency in analyzing, evaluating, and responding to complex service inquiries
Partnering with internal and external resources to provide customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status
Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes
Places outbound welcome calls to members to educate them on their benefits as needed
Assists walk-in members and agents if assigned by leadership
Develop and grow positive, long-term relationships with physicians, providers and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan.
Locations (2)
Las Vegas, Nevada, United States
Nevada, United States
Compensation
$59,300 - $80,900 per year
Responsibilities
Develop and grow relationships with providers
Support financial and quality performance
Interpret and determine appropriate actions
Report to Director, Provider Engagement
Represent scope of health plan/provider relationship
Lead enterprise network planning and implementation across multiple business lines, driving strategic alignment and execution of provider contracting, market expansion, and product launch initiatives.
Responsibilities
Execute enterprise network strategies across Commercial, Medicare, Medi-Cal, and IFP lines of business
Manage implementation plans, milestones, and workstreams supporting multi-year network roadmaps
Gather market, provider, and stakeholder insights to support strategic planning and execution
Drive alignment between network strategy and enterprise growth objectives
Coordinate and execute enterprise provider contracting and renewal playbooks
Requirements
Bachelor’s degree or High School Diploma/GED
Master’s degree in Business Administration, Healthcare Administration, Public Health, Nursing, or related field (preferred)
Nice to have: experience within health plans
Nice to have: experience supporting network expansion
Nice to have: experience with specialty care delivery models
Assist and educate members, employer groups, providers, colleagues, and/or elite agents of health plan benefits with accessing services, facilitating and resolving complex problems, understanding claims, billing and coding, along with other non-routine questions.
Responsibilities
Demonstrates high competency in analyzing, evaluating, and responding to complex service inquiries from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products
Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status
Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes
Places outbound welcome calls to members to educate them on their benefits as needed
Assists walk-in members and agents if assigned by leadership
Responsible for small to mid-size provider recruitment and contracting activities for physicians, physician groups and facilities, developing and negotiating contracts and maintaining relationships with providers to ensure strategic coverage for assigned territory such as Texas.
Compensation
Base Pay Range
$69,800.00 - $125,900.00
Exact compensation may vary based on skills, experience, and location.
Responsibilities
Develop and negotiate contracts
Maintain relationships with providers
Ensure strategic coverage for assigned territory
Educate assigned providers
Travel within assigned areas of responsibility
Requirements
Bachelor Degree
Nice to have: 1+ years experience in facilities, large group, and complex contracting
Nice to have: intermediate level Microsoft Office experience
Nice to have: contract interpretation
Nice to have: advanced analytical and problem-solving skills
Lead the end‑to‑end operation of Florida Blue’s Federal Independent Dispute Resolution (IDR) program, managing a team of specialists, ensuring regulatory compliance, vendor performance, and technology enablement while aligning strategy with network priorities.
Compensation
Annualized Salary Range: $109,300 - $177,600
Responsibilities
Lead, coach, and develop a team of IDR specialists
Plan, organize, direct and control all activities of the department
Act as product owner for IDR technology solutions
Implement and oversee vendor programs
Serve as integrator to provide feedback to policy and network teams
Requirements
Bachelor’s degree in business, healthcare administration, finance, or a related field
Nice to have: advanced degree
Nice to have: experience with the federal No Surprises Act
Lead complex provider contracting and negotiations, manage provider partnerships, oversee contract performance, and provide strategic leadership within SCAN’s Network Management team.
Compensation
Base Pay Range: $168,000-$215,000, Salary + Incentive Plan
Responsibilities
Lead complex provider contracting and negotiations
The Senior Network Contract Manager is a senior individual contributor and subject-matter expert responsible for developing and executing contracting strategies that support affordability, network adequacy, member access, and regulatory compliance.
Locations (2)
Washington, United States
Oregon, United States
Responsibilities
Lead complex provider contracting and negotiations involving hospitals, physician groups, RHCs, FQHCs, and ancillary providers
Negotiate new agreements, renewals, amendments, payment appendices, fee schedules, reimbursement terms, and provider terminations
Develop negotiation strategies based on market conditions, financial performance, provider performance, network needs, and business objectives
Communicate proposed contractual terms clearly and negotiate mutually acceptable agreements with providers
Evaluate continued provider participation based on financial, operational, access, and network considerations
Ensures accurate adjudication of claims by translating medical, reimbursement, and clinical editing policies into effective reimbursement criteria and manages provider exceptions.
Locations (4)
Illinois, United States
Maryland, United States
Virginia, United States
Norfolk, Virginia, United States
Compensation
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $70,800 to $116,820
As a professional within the network contracting and administration team, the incumbent will contribute to the development and maintenance of provider networks. This position is accountable for performing provider and network analysis, evaluating provider reimbursement, and negotiating provider contracts in accordance with corporate strategy.
Compensation
Grade E3: Minimum $62,400 - Maximum $106,929
Responsibilities
Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business
Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies
Identifies, investigates, and analyzes issues and questions
Effectively prepares and presents information, findings, and recommendations to internal and external stakeholders
Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items
Requirements
Bachelor’s degree in Health Care Administration or relevant field
Nice to have: Understanding of medical care delivery
Nice to have: Industry trends analysis
Nice to have: Regional market dynamics understanding
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