Provider Relations Representative

Group 1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina and offers Medicare Prescription Drug Plans in 42 states plus DC.

Why This Role Matters:

The Provider Relations Representative serves as the primary liaison between Clear Spring Health and our provider community. This role is responsible for building and maintaining strong relationships with contracted providers, ensuring they understand plan requirements, operational processes, and tools that support efficient, high-quality care for our members.

The ideal candidate is proactive, professional, and service-oriented—committed to simplifying processes, resolving issues quickly, and ensuring an exceptional provider experience. We are primarily seeking candidates who reside in the state of Georgia, Illinois, or Colorado experienced in the Medicare provider network.

At Clear Spring Health, our mission is to simplify health to enrich lives. We believe in clarity, compassion, and connection — for our members, our providers, and our people. Our culture is built on five action-oriented pillars: Do What’s Right, Serve with Humility, Own It, Grow with Intention, and Innovate with Purpose.

How You'll Contribute:

Provider Engagement & Relationship Management

• Serve as the 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.

Issue Resolution & Support

• Respond promptly to provider inquiries related to claims, authorizations, eligibility, and payment accuracy.
• Coordinate with internal departments and/or TPA (Claims, Credentialing, Enrollment, Utilization Management, etc.) to research and resolve provider issues.
• Track and trend provider concerns to identify opportunities for process improvement.
• Escalate systemic issues to leadership for corrective action and process redesign.

Education & Training

• Conduct provider orientations and ongoing education sessions on Clear Spring Health systems, portals, and resources.
• Ensure providers understand CMS regulations impacting MA plans, including access standards, documentation expectations, and compliance obligations.
• Distribute communications and updates regarding policy changes, coding guidance, and operational enhancements.

Performance Monitoring

• Collaborate internally in regard to monitoring provider performance metrics such as claims turnaround, encounter submission, HEDIS gap closure, and member satisfaction.
• Support provider scorecard initiatives.
• Collaborate with  the Quality team to improve provider performance on key CMS Star measures.

What We're Looking For:

• Bachelor’s degree in Healthcare Administration, Business, or a related field preferred.
• Minimum 3-5 years of experience in CMS and Provider Relations Network Management, or Managed Care Operations (Medicare Advantage experience strongly preferred).
• Working knowledge of CMS requirements and provider network operations.
• Excellent communication, problem-solving, and relationship-building skills.
• Proficient 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:

Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay for this position ranges from $70,000/year in our lowest geographic market up to $90,000/year in our highest geographic market.  Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience.

Benefits Highlights:  

Employees who meet benefit eligibility guidelines and work 30 hours or more weekly, have the ability to enroll in Group 1001’s benefits package. Employees (and their families) are eligible to participate in the Company’s comprehensive health, dental, and vision insurance plan options.  Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long-Term Disability. All employees (regardless of hours worked) have immediate access to the Company’s Employee Assistance Program and wellness programs—no enrollment is required.  Employees may also participate in the Company’s 401K plan, with matching contributions by the Company.  

Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals.  All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.