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Network Provider Relations Representative - Plano, TX

UnitedHealth Group

Plano, TX
Job Code:
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Job Details

743113 Network Provider Relations Representative Plano TX

Network Provider Relations Representative - Plano, TX (743113)

Position Description

Position Description:


Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

Primary Responsibilities:

  • All Customer Service issues regarding Providers contracts.
  • All issues from Agents, Clients.
  • All issues from Providers regarding their contract.
  • Open and maintain tickets with CPO team regarding Provider contract issues and set up.
  • Auditing of all claims for Projects received from UHC.
  • Review all claims in PROS issues and investigate for root cause.
  • Audit Repricing claims.
  • Compare network allowable and determine ppo status to assist with RFP process.

Required Qualifications:

  • High School Diploma / GED
  • 1+ year of healthcare claims and/or network operations experience
  • Familiarity with audit re-pricing of claims and provider related contract issues
  • Experience utilizing Microsoft Word and Excel - Word - creating and editing documents; Excel - creating spreadsheets, filtering and sorting, etc. 
  • 1+ year of Healthcare experience

Preferred Qualifications:

  • Healthcare claims customer service experience

Soft Skill:

  • Ability to work independently and remain on task.
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.


Keywords: UnitedHealth Group, UHG, Provider Service Representative, healthcare claims, network operations, customer service.

Job Details

  • Contest Number743113
  • Job TitleNetwork Provider Relations Representative - Plano, TX
  • Job FamilyNetwork Management
  • Business SegmentEmployer and Individual

Job Location Information

  • Plano, TX
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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