Customer Experience & SupportCustomer Education & Training
About the job
Requirements
Knowledge of health plan operations is preferred.
Knowledge of provider and health plan contracts and agreements is highly desired.
Intermediate proficiency with Microsoft Excel, Microsoft Office, databases, and other Windows-based applications, including spreadsheets, word processing, presentation software, and systems used in data analysis.
Ability to monitor provider capacity, performance, and network adequacy within assigned markets and identify opportunities to improve member access to care.
Ability to evaluate provider performance and network adequacy metrics, identify systemic gaps, and partner cross-functionally to implement solutions that enhance access to care, provider engagement, and overall network effectiveness.
Ability to analyze provider network composition, geographic access, and market conditions to identify opportunities for recruitment, network expansion, and improved provider coverage.
Ability to identify recurring provider issues and operational trends, escalate concerns appropriately, and support implementation of corrective actions.
One year of experience with provider credentialing and contracting processes is preferred.
One to two years of health insurance claims experience and the ability to analyze data to resolve provider claim issues are preferred.
Ability to build strong company-wide relationships and provide support to colleagues.
Ability to take initiative to achieve goals.
Ability to communicate issues, concepts, and ideas orally and in writing.
Ability to focus on member needs.
Ability to manage assignment details thoroughly and with limited oversight.
Ability to adapt to new demands, changes, and situations.
Ability to troubleshoot complex issues, solve problems, and multitask.
Ability to take ownership of actions and decisions and maintain confidentiality when required.
Ability to represent one's interests fairly while working toward solutions with people who hold different or competing views.
Must reside in Mississippi, per contractual requirements.
One to two years of dental office experience.
Comprehension of dental terminology.
High school diploma or equivalent; experience may substitute for education.
Valid driver's license, proof of auto insurance, and ability to use a personal vehicle.
Ability to travel up to 50% to meet prospective clients and existing customers and attend trade shows and other meetings; travel may involve short overnight trips or extended stays.
For this remote role, maintain internet service sufficient to perform essential duties; 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.
Bachelor's degree is preferred.
Certified Dental Assisting National Board (DANB) certification or Certified Dental Assistant (CDA) certification is preferred.
Responsibilities
Conduct provider outreach in person, by video, phone, or email, providing training, orientation, and coaching for performance improvement within provider practices. Educate providers to become more self-sufficient in confirming eligibility, submitting claims, and receiving payment using available tools.
Conduct monthly and/or quarterly meetings with provider groups, documenting discussions, issues, attendees, and action items; research claims or prior authorization issues onsite and route them to the appropriate party for resolution.
Collaborate with the Network Recruitment team to manage contracting for assigned providers, including intake of contracting requests, prompt inquiry response, and network adequacy reviews to ensure organizational and regulatory compliance.
Collaborate with the Credentialing team to manage credentialing for assigned providers, including document intake and prompt inquiry response.
Own and manage relationships and performance for assigned provider groups, serving as the primary point of contact for assigned providers.
Document provider interactions, outreach activities, office visits, provider concerns, and issue resolution in accordance with departmental standards.
Communicate and share provider claims and directory reporting internally and externally, and provide additional reporting as necessary.
Complete provider orientation by phone, email, in person, or virtually for applicable product lines to train, resolve issues, and educate staff and providers.
Support provider adoption of tools, portals, and digital processes that improve administrative efficiency, directory accuracy, and electronic transaction performance.
Perform onsite facility reviews when applicable and conduct quarterly face-to-face visits within the assigned territory and/or market. Coordinate with Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, Account Management, and other staff to develop operational solutions for provider network projects.
Educate providers regarding state programs, group policies, health plan policies and procedures, and state and federal regulatory compliance requirements.
Investigate and respond to complex provider-related issues and initiate changes to provider demographic information in databases.
Respond to general provider contract inquiries, provide provider education, and address non-routine claim issues.
Maintain accurate and timely records to support accountability, reporting requirements, operational effectiveness, and cross-functional communication.
Attend work-related events and conferences while representing the organization professionally.
Coach, mentor, and develop junior team members as applicable.
Desired Qualifications
Knowledge of health plan operations.
Knowledge of provider and health plan contracts and agreements.
One year of experience with provider credentialing and contracting processes.
One to two years of health insurance claims experience and ability to analyze data to resolve provider claim issues.
Bachelor's degree.
Certified Dental Assisting National Board (DANB) certification or Certified Dental Assistant (CDA) certification.
Join us for an exciting career with the leading provider of supplemental benefits!
Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
At Avesis, the Provider Relations Representative (PR2) plays a vital role in connecting our dental provider community with the resources, education, and support they need to thrive. As a key member of our Provider Relations Department, you’ll be the bridge between Avesis and our participating provider network, ensuring that our partners are equipped, informed, and engaged every step of the way. You must reside in the state of Mississippi for this role.
If you’re a self-driven communicator who thrives on building relationships and solving problems, this is the role for you. Your expertise and passion will directly contribute to Avesis’s mission of delivering high-quality, accessible dental care to our members, while also supporting and nurturing the growth of our provider community. Join us in making a meaningful impact in the healthcare space!
In this role, you will live in the state of Mississippi and combine the flexibility of a hybrid work environment with the opportunity to build lasting partnerships both remotely and in the field. You will lead efforts to foster best-in-class provider education, tackle provider inquiries and issues, and manage a variety of initiatives that enhance our relationships with the provider network.
Functional:
Provider Operations encompasses several diverse provider administrative duties to improve the Avesis provider experience including direct provider engagement and training with the goal of resolution of issues.
Conducts provider outreach via in-person/video/phone or email by providing training, orientation, and coaching for performance improvement within provider practices. Provide guidance through education to enable Avesis network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of available tools.
Conduct monthly and/or quarterly meetings with provider groups documenting discussions, issues, attendees, action items, researching claims or prior authorization issues on site and routing to the appropriate party for resolution.
Collaborate with the Network Recruitment team to manage provider contracting for assigned providers, including intake of contracting requests, prompt inquiry response, and network adequacy reviews to ensure organizational and regulatory compliance
Collaborate with the Credentialing team to manage provider credentialing for assigned providers, including document intake and prompt inquiry response
Owns and manages relationships and performance of assigned provider groups. Serves as the primary point of contact for assigned providers.
Documents provider interactions, outreach activities, office visits, provider concerns, and issue resolution activities in accordance with departmental standards.
Communicate and shares provider claims and directory reporting both internally and externally and additional reporting as necessary.
Complete provider orientation via phone, email, in-person and/or virtually for all applicable product lines to train, resolve issues, and educate staff/providers.
Support provider adoption of tools, portals, and digital processes that improve administrative efficiency, directory accuracy, and electronic transaction performance.
Perform onsite facility reviews, when applicable and conduct quarterly face-to-face visits within the assigned territory and/or market. Work closely and coordinate with Avesis Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, Account Management, and other staff to develop operational solutions for various provider network projects.
Educate providers regarding state program, group policies, and/or health plan policies and procedures and state/federal regulations for compliance requirements. Investigate and respond to complex provider related issues and initiate change of provider demographic related database information.
Responds to general provider contract inquiries, provider education and non-routine claim issues.
Maintains accurate and timely records to support accountability, reporting requirements, operational effectiveness, and cross-functional communication.
Attend work-related events/conferences while representing the organization and brand in a professional manner.
Coaches, mentors, and develop junior team members as applicable.
Core:
Knowledge of health plan operations preferred.
Knowledge of provider/health plan contracts/agreements is highly desired.
Microsoft applications and other windows-based applications to include an intermediate level in Microsoft Excel and databases. Knowledge of and intermediate ability to use various computer programs such as Microsoft Office including spreadsheets, databases, word processing and presentation software and programs/systems utilized in data analysis.
Ability to monitor provider capacity, performance, and network adequacy within assigned markets and identify opportunities to improve member access to care.
Ability to evaluate provider performance and network adequacy metrics, identify systemic gaps, and partner cross-functionally to implement solutions that enhance access to care, provider engagement, and overall network effectiveness.
Ability to analyze provider network composition, geographic access, and market conditions to identify opportunities for recruitment, network expansion, and improved provider coverage.
Ability to identify recurring provider issues and operational trends, escalate concerns appropriately, and support implementation of corrective actions.
1 year experience with provider credentialing and contracting process preferred.
1 to 2 years of health insurance claims, as well as ability to analyze data to resolve provider claim issues preferred.
Behavioral:
Collegiality: building strong relationships company-wide, approachable, and helpful, ability to mentor and support team growth.
Initiative: readiness to lead or take action to achieve goals.
Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.
Detail-oriented and thorough: managing and completing details of assignments without too much oversight.
Flexible and responsive: managing new demands, changes, and situations.
Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.
Integrity & responsibility: acting with a clear sense of ownership for actions and decisions and to keep information confidential when required.
Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.
Minimum Qualifications:
Candidates must reside in the state of Mississippi, per contractual requirements.
1 to 2 years of Dental office experience.
Comprehension of Dental Terminology.
High School Diploma or equivalent. (Prefer associate degree or higher); experience may substitute for education.
A valid driver's license with proof of auto insurance and the ability to use your own vehicle.
The ability to travel up to 50% is required to meet prospective clients, existing customers, attend trade shows and other meetings as needed. Travel times may vary and can range from short overnight trips to extended stays.
As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.
Preferred Qualifications:
Bachelor’s degree
Certified Dental Assisting National Board (DANB) certified or Certified dental assistance (CDA).
Equal Employment Opportunity
At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training, and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You!
At Avēsis, we strive to design equitable, and competitive compensation programs. Base pay within the range is ultimately determined by a candidate's skills, expertise, or experience. In the United States, we have three geographic pay zones. For this role, our current pay ranges for new hires in each zone are:
Zone A: $46,080.00-$76,800.00
Zone B: $50,220.00-$83,700.00
Zone C: $54,050.00-$90,080.00
FLSA Status: Salary/Exempt
This role may also be eligible for benefits, bonuses, and commission.
Please visit Avesis Pay Zones for more information on which locations are included in each of our geographic pay zones. However, please confirm the zone for your specific location with your recruiter.
We Offer
Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
Competitive compensation package.
Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
Life and disability insurance.
A great 401(k) with company match.
Tuition assistance, paid parental leave and backup family care.
Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
Employee Resource Groups that advocate for inclusion and diversity in all that we do.
Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.
How To Stay Safe
Avēsis is aware of fraudulent activity by individuals falsely representing themselves as Avēsis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.
Avēsis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during our process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avēsis recruiters will come from a verified email address ending in @ Avēsiscom.
We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to [email protected].
To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avēsis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.
Equal Employment Opportunity
At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You!