Group 1001
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Provider Relations Representative
role at
Group 1001
Company Overview:
Group 1001
is a consumer‑centric, technology‑driven family of insurance companies dedicated to delivering outstanding value and operational performance by combining financial strength and deep insurance expertise with a can‑do culture.
Clear Spring Health
is part of Group 1001 and focuses on providing Medicare Advantage and Prescription Drug Plans in select states. The Provider Relations Representative will serve as the primary liaison between Clear Spring Health and our provider community.
Why This Role Matters The Provider Relations Representative builds and maintains strong relationships with contracted providers, ensuring they understand plan requirements, operational processes, and tools that support efficient, high‑quality care for our members.
Key Responsibilities
Primary contact for contracted physicians, hospitals and ancillary providers within assigned territories.
Educate providers on Clear Spring Health policies, procedures and Medicare Advantage regulatory requirements.
Conduct regular outreach (telephonic, virtual or onsite) to strengthen provider engagement and satisfaction.
Support provider onboarding by ensuring credentialing, contracting and directory data are accurate and up to date.
Respond promptly to provider inquiries related to claims, authorizations, eligibility and payment accuracy.
Coordinate with internal teams and third‑party administrators to resolve provider issues.
Analyze and track provider concerns to identify process improvement opportunities.
Escalate systemic issues to leadership for corrective action.
Conduct provider orientations and ongoing education sessions on Clear Spring Health systems and resources.
Distribute communications on policy changes, coding guidance and operational enhancements.
Collaborate with internal teams to monitor provider performance metrics such as claims turnaround, encounter submission, HEDIS gap closure and member satisfaction.
Support provider scorecard initiatives and work with the Quality team to improve CMS Star measures.
Required Qualifications
Bachelor’s degree in Healthcare Administration, Business or related field (preferred).
3–5 years of experience in CMS and Provider Relations Network Management or Managed Care Operations, with strong Medicare Advantage experience.
Working knowledge of CMS requirements and provider network operations.
Excellent communication, problem‑solving and relationship‑building skills.
Proficiency in Microsoft Office and provider management systems (e.g., CRM, claims or network databases).
Ability to travel up to 25% for provider visits, conferences or network events.
Compensation The base salary ranges from $70,000 to $90,000 per year, depending on geographic market.
Benefits Highlights
Health, dental and vision insurance plans for employees and families.
Basic and supplemental life insurance; short‑ and long‑term disability.
Employee Assistance Program and wellness programs (no enrollment required).
401(k) plan with company match.
Employment Details Full‑time, Mid‑Senior level.
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Provider Relations Representative
role at
Group 1001
Company Overview:
Group 1001
is a consumer‑centric, technology‑driven family of insurance companies dedicated to delivering outstanding value and operational performance by combining financial strength and deep insurance expertise with a can‑do culture.
Clear Spring Health
is part of Group 1001 and focuses on providing Medicare Advantage and Prescription Drug Plans in select states. The Provider Relations Representative will serve as the primary liaison between Clear Spring Health and our provider community.
Why This Role Matters The Provider Relations Representative builds and maintains strong relationships with contracted providers, ensuring they understand plan requirements, operational processes, and tools that support efficient, high‑quality care for our members.
Key Responsibilities
Primary contact for contracted physicians, hospitals and ancillary providers within assigned territories.
Educate providers on Clear Spring Health policies, procedures and Medicare Advantage regulatory requirements.
Conduct regular outreach (telephonic, virtual or onsite) to strengthen provider engagement and satisfaction.
Support provider onboarding by ensuring credentialing, contracting and directory data are accurate and up to date.
Respond promptly to provider inquiries related to claims, authorizations, eligibility and payment accuracy.
Coordinate with internal teams and third‑party administrators to resolve provider issues.
Analyze and track provider concerns to identify process improvement opportunities.
Escalate systemic issues to leadership for corrective action.
Conduct provider orientations and ongoing education sessions on Clear Spring Health systems and resources.
Distribute communications on policy changes, coding guidance and operational enhancements.
Collaborate with internal teams to monitor provider performance metrics such as claims turnaround, encounter submission, HEDIS gap closure and member satisfaction.
Support provider scorecard initiatives and work with the Quality team to improve CMS Star measures.
Required Qualifications
Bachelor’s degree in Healthcare Administration, Business or related field (preferred).
3–5 years of experience in CMS and Provider Relations Network Management or Managed Care Operations, with strong Medicare Advantage experience.
Working knowledge of CMS requirements and provider network operations.
Excellent communication, problem‑solving and relationship‑building skills.
Proficiency in Microsoft Office and provider management systems (e.g., CRM, claims or network databases).
Ability to travel up to 25% for provider visits, conferences or network events.
Compensation The base salary ranges from $70,000 to $90,000 per year, depending on geographic market.
Benefits Highlights
Health, dental and vision insurance plans for employees and families.
Basic and supplemental life insurance; short‑ and long‑term disability.
Employee Assistance Program and wellness programs (no enrollment required).
401(k) plan with company match.
Employment Details Full‑time, Mid‑Senior level.
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