Aetna Senior Provider Relations Representative 43906BR in St Louis, Missouri

Req ID: 43906BR

This position will sit in our St. Louis, MO office location.


Sr Provider Relations Representative is responsible for developing and maintaining positive relationships as well as educating assigned providers in a geographic territory. This position also requires some external meetings with providers.

Fundamental Components:

The Representative ensures positive relationships are maintained with providers by assisting with policy and procedure interpretation, education, and database management. They assist with contract questions, claim processing and payment inquiries/resolutions to achieve provider satisfaction, medical cost targets, and network growth and/or efficiency targets. They are accountable to see provider needs are met and outstanding complex issues are resolved timely. They ensure provider database and documentation is up to date, accurate, and complete and ensure contracts are entered promptly and accurately.


Minimum of 5 years recent and related customer service experience with exposure to benefits interpretation and provider networking. Minimum of 3 years recent and related experience as a Provider Relations Representative. Experience in managed care policy and direction, benefit plan design, and provider fee schedules desired, but not required. Knowledge of ICD-10 and CPT codes desired.


The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.


Functional - Network Management/Provider relations/4-6 Years

Functional - Communications/Provider communications/4-6 Years

Functional - Communications/Communication Delivery - Public Speaking/1-3 Years


Technical - Desktop Tools/Microsoft Outlook/4-6 Years/

Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/


Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care