The Senior Provider Relations Advocate serves as a subject matter expert and strategic liaison responsible for managing complex provider relationships and resolving high-impact claims, payment, authorization, access, data, and operational issues. This role partners closely with providers, internal business partners, payer organizations, and leadership to drive timely resolution, strengthen provider relationships, and continuously improve the provider experience.
The successful candidate will demonstrate strong executive presence, sound judgment, and the ability to effectively navigate challenging or sensitive provider situations. This individual must be skilled at de-escalating concerns, communicating with confidence and credibility, and developing solutions in situations where established processes may not fully address the issue. Exceptional communication skills are essential, including the ability to present effectively to large audiences, facilitate difficult conversations, and develop and deliver provider education and training when needed.
Working with minimal supervision, the Senior Provider Relations Advocate independently researches, analyzes, and resolves complex and often ambiguous issues requiring cross-functional coordination. The role is expected to maintain ownership from initial identification through resolution, identify root causes, drive accountability across business areas, appropriately escalate barriers and risks, and recommend sustainable solutions that reduce operational friction and improve provider outcomes.
The ideal candidate will bring strong analytical, problem-solving, relationship-management, and influencing skills. Claims expertise is solidly preferred, as a significant component of the role involves researching and resolving escalated claims, payment, reimbursement, and related operational issues.
If you are located in Rhode Island, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:- Serve as a senior point of contact for complex and high-impact provider and operational escalations, maintaining end-to-end accountability from intake through resolution
- Develop and sustain solid, collaborative relationships with providers and key healthcare stakeholders throughout Rhode Island, including physicians, hospitals, health systems, provider organizations, medical societies, hospital associations, and healthcare leaders
- Establish meaningful face-to-face engagement with strategic providers and healthcare organizations to strengthen relationships, identify emerging concerns, and advance shared priorities
- Build trusted, long-term provider relationships by effectively communicating organizational priorities, understanding provider perspectives, identifying areas of mutual interest, and supporting network stability
- Collaborate in the development and implementation of appropriate payment and reimbursement models with the provider community
- Provide oversight of activities that support positive physician and hospital relationships, using a collaborative and data-driven approach to identify opportunities and measure progress
- Partner with network providers to identify and execute mutually beneficial initiatives that improve key administrative and operational performance measures
- Implement provider engagement strategies designed to advance quality, efficiency of care, administrative performance, and the overall provider experience
- Serve as a visible and credible representative of the organization within the Rhode Island provider community and with strategic partners
- Foster a culture of inclusion, respect, accountability, collaboration, and commitment to delivering exceptional value to providers
- Demonstrate a continuous-improvement mindset by identifying innovative approaches to resolving problems and improving how services are delivered
- Leverage individual expertise and organizational resources to support the broader goal of improving the healthcare experience
- Assess the severity, business impact, urgency, and appropriate course of action for complex provider issues
- Independently investigate and resolve escalated issues involving:
- Claims and payment discrepancies
- Prior authorization concerns
- Provider and member data issues
- Eligibility concerns
- Provider incentive payment disputes
- Access and technology-related issues
- Operational and service-related concerns
- Facilitate timely resolution of provider issues through effective coordination and accountability across multiple business areas
- Analyze claim adjudication outcomes, payment methodologies, remittance information, contractual considerations, and provider reimbursement concerns to determine appropriate resolution pathways
- Partner effectively with Claims Operations, Payment Integrity, Health Plans, Network Management, Contracting, Clinical Operations, Technology, and other stakeholders to resolve complex issues
- Educate providers and internal business partners regarding claims processes, policies, operational requirements, and available resolution pathways
- Conduct detailed investigations into complex provider and operational issues, separating isolated concerns from broader systemic opportunities
- Analyze trends, recurring issues, and systemic barriers affecting provider satisfaction, administrative performance, and operational effectiveness
- Identify root causes and recommend sustainable corrective actions rather than relying solely on short-term issue resolution
- Develop recommendations to improve processes, workflows, service delivery, and the provider experience
- Translate complex findings, data, and operational challenges into clear, actionable recommendations for business partners and leadership
- Serve as a trusted advocate for providers while appropriately balancing provider needs with contractual requirements, organizational policies, regulatory requirements, and business objectives
- Communicate complex or sensitive information clearly, professionally, diplomatically, and with a solutions-oriented approach
- Build effective partnerships across Operations, Network Management, Claims, Payment Integrity, Contracting, Client Services, Quality, Clinical Operations, Technology, payer organizations, and other business areas necessary to resolve provider concerns
- Influence outcomes across teams where direct authority may not exist by establishing clear accountability, maintaining effective communication, and driving issues toward resolution
- Identify and appropriately escalate systemic issues, emerging risks, operational barriers, and provider relationship concerns to leadership
- Provide leadership with clear summaries of significant issues, business impact, root causes, recommended actions, and potential risks when escalation is required
Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- High school diploma or equivalent
- 5+ years of healthcare and/or managed care experience
- 3+ years of provider relations and/or provider network management experience
- Experience independently researching and resolving complex provider or operational issues
- Experience presenting information to groups and facilitating professional discussions
- Demonstrated experience managing challenging customer or provider interactions and effectively de-escalating concerns
- Proficiency with Microsoft Word, Excel, PowerPoint, Access, and related business applications
- Demonstrated problem-solving, analytical, and critical-thinking skills
- Proven excellent written and verbal communication skills, with the ability to tailor communication to providers, business partners, and leadership audiences
- Demonstrated ability to manage competing priorities and multiple complex issues in a fast-paced environment
- Demonstrated ability to influence outcomes through collaboration, credibility, and relationship building
- Demonstrated ability to exercise sound judgment and make decisions in complex or ambiguous situations
- Must reside in Rhode Island
Preferred Qualifications:- Claims processing, claims operations, and/or complex claims-resolution experience
- Experience with provider reimbursement, payment integrity, claims adjudication, and/or prior authorization workflows
- Experience managing complex or high-profile provider escalations
- Experience working with physicians, hospitals, health systems, and senior healthcare leaders
- Experience conducting root cause analysis and implementing sustainable process improvements
- Experience working across operational, clinical, financial, contracting, and technology teams to resolve complex issues
- Experience developing or delivering provider education, presentations, or training
- Knowledge of healthcare provider operations and managed care environments
*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, youll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
