Top 2049 Member services representative Jobs in Miami, Fl

Provider Relations Representative (Hybrid)
Genuine Health Group —Miami, FL
- Full-time
- Hybrid work
- Spanish
- Clean driving record
- Up to 50% travel
- Free parking
- Health savings account
Quick Apply
Concierge Manager - RIVANI Class X
Black Briar Management —Miami Beach, FL
- $75,000 - $100,000 a year
- Full-time
- Background check
- Spanish
- 5 years
- Free parking
- Health insurance
Community Association Manager/ Property Manager
Altitude Management Group —Sunny Isles Beach, FL
- From $150,000 a year
- Weekends as needed
- Background check
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
1d
General Manager (LCAM) (5 Star Residential Miami 33129)
Marquis Association Management —Miami, FL
- $145,000 a year
- Full-time
- Background check
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
Enrollment Services Representative - Miami Campus
FVI School of Nursing and Technology —Miami, FL
- $48,000 - $58,000 a year
- Full-time
- Bilingual
- University
- Education
- Health insurance
- Dental insurance
Quick Apply
Representative, Support Center
Molina Healthcare —Miami, FL
- $14.00 - $28.82 an hour
- Overtime
- Sales
- Computer literacy
- HIPAA
- Health insurance
8d
Ticket/Gate Agent (Customer Service Agent) - MIA
Delta Airlines —Miami, FL
- From $20.55 an hour
- Full-time
- 18 years or older
- High school
- Computer literacy
- Paid parental leave
- Paid holidays
2d
Family Practice Physician
Vesa Health & Technology, Inc —Miami, FL
- Full-time
- Medicine
- BLS Certification
- Internal Medicine
- Travel reimbursement
- Relocation assistance
Quick Apply
3d
Health Claims Examiner
National Employee Benefits Administrators, Inc. (NEBA) —Pembroke Pines, FL
- From $19 an hour
- Full-time
- Writing skills
- Medical office experience
- Basic math
- Health insurance
- Dental insurance
Quick Apply
14d
Speech Therapist Part Time
Ann Storck Center —Fort Lauderdale, FL
- Part-time
- Classroom
- Computer literacy
- Adults
Physical Therapist Assistant
Fyzical Miami- Little River —Miami, FL
- $30.00 - $32.66 an hour
- Full-time
- CPR Certification
- Anatomy knowledge
- Vital signs
- Continuing education credits
Quick Apply
Sales Consultant
Haverty Furniture Companies, Inc. —Pembroke Pines, FL
- $55,000 - $100,000 a year
- Weekends as needed
- Computer literacy
- Microsoft Office
- High school diploma or GED
- Paid training
- Wellness program
Quick Apply
NCCT Medical Office Assistant Bootcamp Instructor
California Institute of Applied Technology —Florida
- $33 - $38 an hour
- 8 hour shift
- Remote
- Microsoft Word
- Microsoft Excel
- Medical office experience
- Work from home
- Flexible schedule
Marketing Representative
South Florida Pulmonary and Critical Care Associates —Miami-Dade County, FL
- $18 - $20 an hour
- Full-time
- Mid-level
- Analysis skills
- In-person
- Paid time off
Quick Apply
Licensed Practical Nurse (LPN) Nights - 3/12s
VITAS Healthcare —North Miami Beach, FL
- Part-time
- Nursing
- Mid-level
- Medical-surgical
- Disability insurance
- Health insurance
Quick Apply
Financial Advisor
Retirement Consultant Services —Fort Lauderdale, FL
- $90,000 - $120,000 a year
- Full-time
- Background check
- Research
- Mid-level
- 401(k)
- Paid time off
Quick Apply
Grant Manager
Feeding South Florida —Pembroke Park, FL
- $65,000 - $75,000 a year
- Full-time
- Computer literacy
- Research
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
8d
Slot Shift Manager
Calder Casino —Miami Gardens, FL
- Mid-level
- 3 years
- Ability to lift 50 pounds
- Employee stock purchase plan
- Disability insurance
Quick Apply
8d
New York Life Accelerated Path to Management Program
New York Life —Miami, FL
- $60,000 - $150,000 a year
- Weekends as needed
- Hybrid work
- Bilingual
- Background check
- Sales
- AD&D insurance
- Disability insurance
Quick Apply
HVAC Comfort Advisor
ARS-Rescue Rooter —Miami, FL
- From $100,000 a year
- Full-time
- Background check
- Clean driving record
- Pass drug screening
- Fuel card
- Health savings account
8d

I want to receive the latest job alert for member services representative in miami, fl

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

member services representative jobs near miami, fl

Provider Relations Representative (Hybrid)

Genuine Health Group -
Miami, FL

Quick Apply

Job Details

Full-time

Benefits

Free parking
Health savings account
Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Parental leave
Employee assistance program
Vision insurance
401(k) matching
Employee discount
Life insurance
Referral program
Retirement plan

Qualifications

Spanish
Medicare
Medicare coding guidelines
CMS
CMS regulatory compliance
Quality performance measurement
Driver's License
Bachelor's degree
Health insurance knowledge
Medicare regulations
Clinical performance metrics
Driving
Clinical program data analysis
Relationship management
Business Administration
Financial performance measurement
Cross-functional collaboration
Clinical data analysis
Healthcare performance metrics analysis
Cross-functional communication
HEDIS

Full Job Description

Summary:

This high-impact role serves as a key liaison between Genuine Health Group and its provider networks, driving performance across quality metrics, risk adjustment, and total cost of care. The ideal candidate brings deep knowledge of value-based care models and excels at building trust-based partnerships with physicians and practice leaders. Leveraging data insights and field expertise, the Provider Relations Representative delivers targeted education, monitors key financial and clinical indicators, and leads strategic interventions to improve outcomes and provider satisfaction. This role is critical to strengthening engagement, supporting sustainable growth, and ensuring our providers thrive in today’s evolving healthcare landscape. The Provider Relations Representative role requires frequent travel throughout their assigned areas.

Essential Duties and Responsibilities:

Serve as the primary liaison between assigned provider groups, Genuine Health, and health plan partners, ensuring clear communication and alignment on shared performance goals.
Educate providers and their staff on contractual obligations, incentive programs, and clinical best practices to drive improvements in Quality, Risk Adjustment, Growth, and Total Medicare Cost.
Conduct new provider ongoing trainings on healthcare delivery models, health plan partnerships, patient care plans, and operational workflows.
Maintain proactive, open lines of communication with providers to address and resolve issues related to claims, eligibility, utilization management, quality metrics, and risk adjustment programs.
Monitor and communicate ongoing performance against Key Performance Indicators (KPIs), including those tied to the Genuine Rewards Program, and provide actionable insights for improvement.
Collaborate with provider groups to develop, implement, and track performance improvement plans aimed at enhancing patient outcomes, financial sustainability, and care quality.
Lead strategic provider meetings, including scheduling, agenda development, preparation of materials, and documentation of key discussion points and next steps.
Engage cross-functionally with departments such as Quality, MRA, Case Management, Contracting, and Clinical Operations to align support efforts and drive group performance.
Partner with the contracting team to ensure provider data accuracy and facilitate necessary updates.
Participate in internal leadership and strategy meetings to provide insights from the field and support strategic planning.
Conduct regular in-person practice visits (minimum 60% of work week) in accordance with Genuine Health’s high-touch provider engagement model.
Develop and execute outreach strategies to engage high-performing specialists and ancillary providers, promoting best practices and improved referral relationships.
Cultivate long-term provider partnerships through consistent communication, professional responsiveness, and a collaborative problem-solving approach.
Drive measurable improvement in Stars ratings, risk score accuracy, and medical cost performance across assigned provider panels.
Contribute to network-level targets in member retention, provider satisfaction, and quality improvement benchmarks.
Adapt to evolving CMS requirements and organizational strategies by proactively aligning provider education and outreach initiatives.
Perform other duties as assigned.

Knowledge, Skills and Abilities

Deep understanding of Medicare Advantage, CMS regulations, HEDIS, Star Ratings, and Medicare Risk Adjustment (HCC coding).
Strong knowledge of value-based care models, ACO operations, and managed care delivery systems.
Ability to interpret and apply contractual terms, provider performance data, and incentive program structures.
Proven ability to analyze and act on clinical, financial, and operational data to influence provider behavior and improve performance.
High emotional intelligence with strong relationship-building, conflict resolution, and negotiation skills.
Strong organizational and time-management skills with the ability to prioritize multiple high-impact initiatives.
Demonstrated ability to lead provider meetings and trainings with clarity, professionalism, and purpose.
Ability to work independently and collaboratively in a field-based role that requires consistent travel and adaptability.
Deep commitment to quality improvement, provider engagement, and delivering exceptional patient-centered care.

Minimum Education and Experience

5+ years of experience in a healthcare-related role required; preference for candidates with backgrounds in Medicare Advantage, ACOs, or Managed Services Organizations (MSOs).
3+ years of experience in Provider Relations, Network Management, Contracting, or Credentialing, with direct experience engaging physician groups and driving performance outcomes.
Bachelor’s degree preferred in Health Administration, Business, or a related field (or equivalent combination of education and experience).
Demonstrated experience working with CMS regulations, HEDIS, Star Ratings, and Medicare Risk Adjustment (HCC coding).
Proven ability to analyze and act on clinical and financial performance data (e.g., MLR, utilization, gaps in care).
Experience collaborating cross-functionally with internal teams such as Quality, Risk, Case Management, and Contracting.
Bilingual fluency in English and Spanish – written and verbal – is preferred.
Prior experience in a field-based, provider-facing role with regular travel is strongly preferred.
Valid Florida driver’s license, clean driving record, and reliable transportation required.

Note: Nothing in this job specification restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons. The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.

Job Type: Full-time

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Employee discount
Flexible spending account
Free parking
Health insurance
Health savings account
Life insurance
Paid time off
Parental leave
Referral program
Retirement plan
Tuition reimbursement
Vision insurance

Application Question(s):

Will you now or in the future require sponsorship for employment visa status?
Please describe your knowledge of HEDIS.
What are your salary expectations?
This is a hybrid role that requires travel within Miami-Dade and/or Broward County. Are you willing to commute to these areas as part of this job's travel responsibilities?

Experience:

Medicare Advantage, ACOs, or MSOs: 5 years (Required)
Provider Relations: 3 years (Required)

License/Certification:

Florida driver's license (Required)

Ability to Commute:

Miami, FL 33134 (Required)

Willingness to travel:

50% (Required)

Work Location: On the road

Quick Apply

Refine Your Search

member services representative jobs in miami, fl

Provider Relations Representative (Hybrid)

Concierge Manager - RIVANI Class X

Community Association Manager/ Property Manager

General Manager (LCAM) (5 Star Residential Miami 33129)

Enrollment Services Representative - Miami Campus

Representative, Support Center

Ticket/Gate Agent (Customer Service Agent) - MIA

Family Practice Physician

Health Claims Examiner

Speech Therapist Part Time

Physical Therapist Assistant

Sales Consultant

NCCT Medical Office Assistant Bootcamp Instructor

Marketing Representative

Licensed Practical Nurse (LPN) Nights - 3/12s

Financial Advisor

Grant Manager

Slot Shift Manager

New York Life Accelerated Path to Management Program

HVAC Comfort Advisor

I want to receive the latest job alert for member services representative in miami, fl

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected