Clever Care Community Centers are now open in San Gabriel, Westminster, and Koreatown! Click here to learn more.

About Clever Care Health Plan

Clever Care Health Plan is a newly founded Medicare Advantage health plan serving Medicare beneficiaries in Southern California. Our employees are passionate in providing best services to our members and healthcare providers. Our three office locations are in Arcadia (Los Angeles County), Huntington Beach (Orange County) and New York City.

Job Summary

Supports the Provider Relations Field Representative to achieve department goals. Responds to customer service and provider relations inquiries from providers and assist with problem resolution of issues. Coordinate’s provider submissions to internal departments via required forms.

Functions and Job Responsibilities

  • Build provider awareness of and engagement with Clever Care Health Plan
  • Proactive research and resolution of provider issues including but not limited to claims submission, processing, and payment; contracting details; provider tools; and UM and other protocols.
  • Works directly with internal and external partners to collect all required information to ensure correct processing of contracts, amendments, and update requests.
  • Works with delegated providers and IPAs to process new provider load requests along with any updates or changes within the group via a roster methodology.
  • Performs root cause analysis of delays in provider loading and assists in bringing to
  • Achieves call reach and frequency goals to establish consistent and strong relationship with provider offices.
  • Ensure accurate ongoing collection of key provider data element updates and
  • Provides oversight on inquires and claims issues and follows up with providers to ensure problems have been resolved.
  • Strategizes for membership growth and retention.
  • Collaborate with Marketing, Sales, Provider Data, Credentialing, Operations, and other teams to coordinate cross-functional in-market activities.
  • Provide high level of customer
  • Special projects as assigned or directed.

Education and Experience

  • Associate degree in a related field
  • Three (3) or more years of experience in the healthcare industry
  • Three years of navigating relationships around providers and insurance networks is

Knowledge, Skills, and Abilities

  • Demonstrated ability to manage multiple projects and meet deadlines
  • Strong communication and presentation skills with ability to effectively communicate with all levels of the organization, internally and externally
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Physical & Working Environment

Typical Physical Demands.
Position requires a great amount of sitting and standing. Some lifting, stooping, bending, or reaching is required. May require lifting up to 15‐30 pounds. Requires manual dexterity sufficient to operate a computer, calculator and telephone. Requires normal range of hearing and vision. Requires the ability to type and file.

Typical Working Conditions.
Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. Work may be stressful at times. May occasionally work some irregular hours.

Apply for the Provider Operations Associate position at Clever Care Health Plan