Associate, Provider Relations & Contracting

Summary

Join Clover Health as a Provider Relations & Contracting Associate and serve as the primary liaison between Clover Health and its provider network. This field-based role requires expertise in provider relations, HEDIS, contracting, and partnership development. Key responsibilities include educating providers on Clover Health initiatives, ensuring policy compliance, resolving issues, and supporting sales growth. You will build strong provider partnerships, deliver exceptional customer service, and improve care coordination for Clover members. The position involves regular site visits, training, and presentations to providers and their staff. Success will be measured by high provider retention, network growth, and the development of strategic partnerships.

Requirements

• You have 5+ years of healthcare industry experience in one or more of the following areas: provider network management, provider relations, insurance operations, or payment integrity functions
• You have a strong background in provider relations, HEDIS, contracting, and partnership development
• You are based in North New Jersey
• You are bilingual in Korean and English (required)
• You have a valid New Jersey driver’s license and reliable transportation
• You thrive in an external-facing, field-based role and enjoy engaging directly with healthcare providers, including physicians and office staff
• You're skilled at building and managing relationships with healthcare providers, ensuring their satisfaction and education on key initiatives
• You're adept at delivering training and presentations to both individual providers and larger groups, such as health system executives
• You have experience supporting network growth and optimization initiatives within a healthcare payer environment
• You're committed to improving administrative cost effectiveness, member satisfaction (CAHPS), and quality programs through provider engagement

Responsibilities

• Be the face of Clover to market’s healthcare providers and serve as the primary point of contact for any/all assigned providers/practices, including those who are Korean-speaking
• Support the formulation of various physician engagement strategies as part of building mutually beneficial partnerships in provider networks
• Execute on provider contracting initiatives by engaging key providers throughout key markets
• Manage provider relationships; engage contracted primary care and specialty physicians on a regular basis
• Address and resolve operational challenges raised by network providers and effectively communicate those needs to internal stakeholders
• Coordinate regular data transfer and feedback loops between physicians and Clover to ensure internal & external administrative cohesion
• Conduct regular provider site visits within the assigned region/service area
• A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Clover policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Clover members
• Provide on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship
• Take initiative in preventing and resolving issues between the provider and the Plan whenever possible
• The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters
• Independently deliver training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan
• May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's)
• Perform an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various initiatives
• Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.)
• By the end of your 90-day period: System Navigation: Demonstrate proficiency in navigating and utilizing key internal systems for provider outreach, logging interactions, tracking issues, and accessing relevant provider data
• Network growth and Relationship Building: Encourage provider participation in HEDIS and other quality programs, leveraging your foundational knowledge of Clover Assistant to demonstrate their importance for member outcomes
• By 6 months: Consistent Engagement: Maintain a regular cadence of communication and site visits with all assigned providers/practices, demonstrating consistent engagement and responsiveness
• Educational Delivery: Independently deliver comprehensive training and presentations to assigned providers and their staff on various Clover Health topics, answering questions confidently
• Issue Resolution: You'll adeptly resolve provider issues through cross-departmental collaboration and independent problem-solving, leveraging your deep understanding of Clover Assistant to enhance care delivery and directly improve Stars measurement and overall plan performance
• Future success in this role will be measured through: High Provider Retention: Consistently achieve high retention rates for assigned providers within the Clover network, indicating strong, mutually beneficial partnerships
• Network Growth & Optimization: You'll play a vital role in optimizing our existing provider network in New Jersey. Directly contribute to sales and membership growth initiatives by ensuring a robust, engaged, and high-performing provider network
• Partnership Development: Cultivate deep, strategic partnerships with high-priority providers and health systems, leading to collaborative programs, shared goals, and enhanced value for members

Benefits

• Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities
• Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions
• We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage
• Your health matters to us, and we invest in ensuring you have access to quality healthcare
• We understand the importance of mental health in fostering productivity and maintaining work-life balance
• To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy
• Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location
• Developing internal talent is a priority for Clover
• We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents