Associate, Provider Relations & Contracting (Korean Bilingual)

Clover is reinventing health insurance by working to keep people healthier.

At Clover Health, we bring high-quality, affordable, and easy-to-understand healthcare plans to America’s seniors. We focus on preventive care and leverage data and technology from the Clover Assistant to empower physicians to make the best health recommendations based on our members’ complete health history—all with the lowest cost and the highest value.

The Provider Relations & Contracting Associate serves as the primary liaison between Clover Health and our provider network, including Fee-For-Service and Pay for Performance providers. This external-facing, field-based position requires expertise in provider relations, HEDIS, contracting, and partnership development to effectively engage high-priority providers and their staff.

Key responsibilities include educating providers on Clover Health initiatives, ensuring policy compliance, resolving issues promptly, and supporting sales growth, Clover Assistant and HEDIS Gaps-in-Care management. The role focuses on building strong provider partnerships while delivering exceptional customer service and driving improved coordination of care for Clover members.

As an Associate, Provider Relations & Contracting, you will:

• 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.).

Success in this role looks like:

• 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 issue