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Provider Relations Representative Ii Jobs (NOW HIRING)

Genex

Provider Relations Manager, MRS

Schaumburg, IL · On-site

This position is responsible for direct oversight of provider relations representatives working in a call-center environment. Handles hiring, coaching, and overall management of a team of 10-12 ...

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Provider Relations Representative II information

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$41

How much do provider relations representative ii jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for provider relations representative ii in the United States is $27.89, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $31.49 per hour, depending on experience, location, and employer.

What is a provider relations representative II?

A Provider Relations Representative II is a healthcare professional who acts as a liaison between healthcare providers, such as doctors or clinics, and insurance companies or managed care organizations. They handle complex issues, ensure providers understand policies and procedures, and help resolve disputes or claims. This role typically involves a higher level of experience and responsibility than entry-level positions, including training new staff and handling escalated cases. Strong communication and problem-solving skills are essential for success in this position.

What are the key skills and qualifications needed to thrive as a provider relations representative II, and why are they important?

To excel as a Provider Relations Representative II, you need strong knowledge of healthcare administration, provider contract management, and a bachelor’s degree in a related field. Familiarity with claims processing systems, CRM software, and healthcare regulations such as HIPAA is typically required. Outstanding interpersonal skills, problem-solving abilities, and effective communication are crucial for building trust with providers and resolving issues efficiently. These skills ensure smooth provider network operations, compliance, and high levels of provider satisfaction.

How does a provider relations representative II typically collaborate with healthcare providers to resolve issues and ensure smooth operations?

A Provider Relations Representative II works closely with healthcare providers to address concerns related to claims processing, contract terms, and network participation. They act as a liaison between providers and the insurance company, facilitating communication and problem-solving. This often involves organizing meetings, conducting training sessions, and following up on outstanding issues to ensure providers have the support they need. Strong relationship-building and conflict resolution skills are essential, as representatives frequently collaborate with internal departments and external partners to maintain positive, productive partnerships.

What is the difference between Provider Relations Representative Ii vs Provider Relations Representative I?

AspectProvider Relations Representative IiProvider Relations Representative I
Required CredentialsHigh school diploma or equivalent; some roles may prefer healthcare or insurance certificationsHigh school diploma or equivalent; entry-level position
Work EnvironmentOffice-based, interacting with healthcare providers and insurance staffOffice-based, supporting provider networks and customer service
Employer & Industry UsageHealthcare insurance companies, managed care organizationsHealthcare insurance companies, managed care organizations
Common Search & ComparisonProvider Relations Representative Ii vs Provider Relations Representative IProvider Relations Representative I

The Provider Relations Representative II typically requires more experience and may handle more complex provider issues compared to the Provider Relations Representative I. Both roles are essential in maintaining provider networks within healthcare insurance companies, but the 'II' level often involves greater responsibilities and expertise.

More about Provider Relations Representative II jobs
What job categories do people searching Provider Relations Representative Ii jobs look for? The top searched job categories for Provider Relations Representative Ii jobs are:
Provider Relations Representative II jobs near you
Infographic showing various Provider Relations Representative Ii job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $58,011 per year, or $27.9 per hour.

Telephone Representative II (Provider Relations)

1199SEIU Funds

Manhattan, NY • On-site

Other

Medical, Dental, Vision

Re-posted 14 days ago

Job description

Job Title

Responsibilities

Communicate with doctors, hospitals, and other professionals via telephone regarding 1199SEIU members, dependent eligibility for health benefits, claims, and other plan services

Verify and determine eligibility for members, spouses, dependents, including the reinstatement of terminated coverage

Research and request documentation for provider enrollment, credentialing and provider file updates

Research and provide schedule of allowance for procedure codes and prior authorization requirements, research check reconciliation of claim payments

Accurately and professionally respond to telephone inquiries regarding member benefits and claims

Examine dental, vision, hospital, and medical claim histories for claim status, accuracy and timeliness

Create call tracking records in call tracking system (QNXT) to the appropriate call tracking folders for resolution; mail printed materials upon request

Review call tracking items returned to individual folder for closure or assignment to correct call tracking folder as required

Assign claim inquiries, enrollment, and eligibility issues to appropriate call tracking folders for resolution

Generate call tracking inquiries for problems related to all of the above for correction

Advise providers of new programs, plan improvements and plan changes

Verify provider inquiry using Knowledge Tool (BeneFAQs, QNXT, DocFind, iObserver)

Retrieve and review scanned claim images using IRIS System

Perform additional duties and projects as assigned by management

Qualifications

High School Diploma or GED required; Some College or Degree preferred

Minimum two (2) years high volume customer service experience in a call center environment; or two (2) years health claims processing experience required

Excellent keyboarding skills required.

Experience using web-based applications, basic knowledge of health claims processing systems (QNXT, Vitech) and Fund eligibility requirements preferred (National Benefit Fund, Greater New York Fund, Home Care Fund); experience with Provider Relations a plus

Excellent written and verbal communication skills with great interpersonal skills

Ability to initiate own correspondence and maintain a pleasant attitude to ensure excellent service to members and providers

Ability to multi-task and work under pressure due to volume and urgent nature of calls

Call center hours of operation are from 8:00 am - 6:00 pm; shifts are subject to change and/or availability

Apply