Internal Provider Network Rep II

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. Come join us and be part of a purpose driven company who is invested in your future! Job Summary This position is responsible for providing assistance to practitioners in resolution of claims, pricing, coding and contract issues; and working with internal departments to evaluate and resolve provider/contract and service issues. Handle more complex issues and may assist in training/mentoring staff. JOB REQUIREMENTS: * Bachelor degree and two years experience resolving network management issues OR 6 years health care experience with two years resolving network management issues * Knowledge of and experience with health care policies, products and procedures; contracts, applications and products. * Knowledge of claims processing systems. * PC proficiency including Word and Excel. * Verbal and written communication skills; teamwork, and problem solving skills; analytical skills * Organizational skills and experience meeting deadlines and working well under pressure. PREFERRED JOB REQUIREMENTS: * Leadership/training skills. * Self-starter that demonstrates strong initiative and a proactive personality. * Ability to perform detailed work with a high degree of accuracy and minimal guidance. * Strong communication and analytical skills enabling them to provide explanations and information to others on difficult issues. * Understand Commercial Claim issues & resolution. * Identifies solutions to non-standard requests and problems. * Provider data loading or other healthcare database maintenance. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities. Join our Talent Community. For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Legal and Privacy Health Care Service Corporation is an Equal Opportunity Employment / Affirmative Action employer Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2022 Health Care Service Corporation. All Rights Reserved.