Provider Relations Resume Sample

Updated on: February 26, 2016


Bad resumes are like rolling stones. They gather no moss – read that as interviews. An interview is the most important stage in the job application process but in order to reach it, you have to step on the first stepping stone – the resume. This particular stage is where the whole job application business begins. And this is where it needs to be the “best”. Fair enough?

Take a look at a resume sample of a provider relations representative position as an example:


Provider Relations Resume Sample


Paul Young

1850 Clark Road ● Tilton, NH 88987● (000) 999-1452 ● paulyoung @ email . com


Performance Summary: Enthusiastic provider relations representative with 9 years’ extensive experience in building and maintaining relationships with users and providers, aimed at providing high level of customer services. Effectively able to review claims documents and handle payment recoveries. Documented success in:

• Efficiently and accurately managing provider demographic information such as tax identification numbers and new addresses
• Handling expansion of mails, tracking spreadsheets and managing auditing and tracking duties
• Investigating and resolving member complaints regarding providers to ensure satisfaction at both levels
• Proactively identifying provider needs and advising management of ways to address their needs


• Complaints Investigation • Resolution Facilitation
• Deficiency Identification • Access and Availability
• Incentive Programs Facilitation • Membership Growth and Retention
• Compliance Assurance • Outreach
• Provider Education • Auditing
• Contract Negotiations • Provider Needs Identification


CHS SERVICES, Tilton, NH | July 2011- Present
Provider Relations Representative

• Foster strong, positive relationships with all 50 providers on the panel, making it easy for the organization to handle problems
• Investigate a provider problem resulting in increased customer satisfaction
• Build positive relationships between health plans, providers and practice managers
• Identify and remediate claims to ensure early resolution of claims problems
• Assist providers in setting up and utilizing provider portals and networks
• Answer and service departmental telephone calls and provide exceptional services to callers
• Create and maintain provider contract files in a safe and confidential manner
• Assume lead for special projects by assisting with mail expansions and tracking spreadsheets
• Assist with full range of provider relations and service interactions such as end to end provider claim and call quality training
• Provide support by handling queries regarding claim statuses of medical and dental nature

AVESIS INCORPORATED, Tilton, NH | May 2006 – July 2011
Provider Relations Specialist

• Proactively identified provider needs and advised on various methods of meeting those needs, resulting in process improvement
• Identified a network deficiency, which if left unaddressed would have created a huge loophole in both service and provider relations
• Took telephone calls and provided information regarding statuses of claims
• Assisted in investigating and resolving member complaints regarding providers
• Provided support in establishing and fostering strong relationships with all members
• Educated providers on incentive programs and facilitated retrieval of member healthcare records
• Assisted with credentialing audits and on-site provider assessments

Bachelor’s Degree in Health Care Administration