Provider Relations Representative

Humana

. Serve as primary relationship manager for assigned providers to ensure a positive provider experience and promote network retention .

Posted 11/2/2026full-timeRemote • Illinois • United StatesJuniorMid-Level💰 $59,300 - $80,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in provider relationship management, onboarding, and training within the managed care sector, with a strong focus on compliance and effective communication of policies and procedures.

Highest-signal resume keywords

Provider Relationship ManagementHealth Care ExperienceManaged Care ContractsBehavioral Health Provider ExperienceClaims Systems Understanding

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Provider OnboardingClaims SubmissionReimbursement ProcessesContract Language UnderstandingRegulatory ComplianceFinancial ArrangementsService CoordinationValue-Based Payment ProgramsDispute ResolutionMedical Record Management

Soft Skills

Exceptional Interpersonal SkillsRelationship ManagementEffective CommunicationTraining and Education

Tools & Technologies

AvailityClaims SystemsProvider Enrollment Systems

Certifications & Qualifications

Valid State Driver's LicensePersonal Vehicle Liability InsuranceTuberculosis (TB) Screening

Industry Keywords

Managed CareIllinois MedicaidCommunity Mental Health CentersProvider OperationsHealth Plan Processes

About the role

Key responsibilities & impact

Serve as primary relationship manager for assigned providers to ensure a positive provider experience and promote network retention
Meet regularly, both in-person and virtually, with assigned providers for training and education
Support newly assigned providers with onboarding and host orientation sessions
Respond to provider inquiries and support prompt issue resolution
Collaborate with enterprise business teams such as claims payment, prior authorizations, and referrals
Use internal resources and systems, including claims, reimbursement, and provider enrollment systems
Create provider trainings based on feedback, claims trends, and process changes
Educate providers on provider-facing materials
Organize and convene regular provider meetings, including agendas, materials, and minutes
Educate providers on claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, quality resources, and member resources
Communicate Humana policy and procedure updates and Cardinal Care programmatic updates
Coordinate regional provider town halls and trainings
Attend network meetings and conferences
Ensure compliance with Virginia managed care contractual requirements for provider relations

Requirements

What you’ll need

Candidate must reside within Cook County in Illinois
2 or more years of health care or managed care experience working with providers
Experience with Illinois Medicaid
Experience working with Behavioral Health providers and Community Mental Health Centers
Experience in provider operations, building strong relationships with provider organizations, financial/contracting arrangements, and/or regulatory requirements
Exceptional relationship management and interpersonal skills
Thorough understanding of managed care contracts, including contract language and reimbursement
Position is field based in Illinois and requires frequent travel to provider and Humana locations
Valid state driver's license
Maintain personal vehicle liability insurance meeting applicable minimum requirements
Required to undergo tuberculosis (TB) screening
Minimum home internet speed of 25 Mbps download and 10 Mbps upload
Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information
Preferred: Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution
Preferred: Understanding of service coordination, prior authorizations, and other health plan processes
Preferred: Understanding of value-based payment programs

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical, dental, and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Dedicated home workspace and internet requirements for remote work
Occasional travel to Humana offices for training or meetings