Reporting to the Manager, Provider Relations, the Health Plan Provider Engagement Representative serves as the primary contact for assigned healthcare partners, building and maintaining professional relationships that support high-quality service delivery and provider satisfaction. This field-based role is responsible for face-to-face engagement, onboarding, education, and issue resolution across multiple operational and clinical topics. The Representative supports SFHP initiatives by promoting provider awareness, ensuring compliance with protocols, and facilitating collaboration across our teams and external stakeholders.

You will be accountable and service oriented. You are experienced in building relationships, managing provider interactions, and resolving complex issues independently. You will show and deliver high-quality work.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $36 - $40 per hour

WHAT YOU WILL DO:

• Resolve provider issues related to claims submission, processing, and payment; contracting details; prior authorizations; provider tools; member grievances; and regulatory protocols.
• Support new provider onboarding and orientation to SFHP programs, systems, and expectations.
• Promote provider awareness and engagement with SFHP initiatives, including quality improvement, compliance, and operational enhancements.
• Collaborate with our teams to ensure provider needs are addressed and feedback is communicated.
• Maintain accurate documentation of provider interaction, issue resolution activities.
• Manage a high-volume workload, ensuring completion of responsibilities within budget and deadlines.
• Prepare clear, and grammatically correct communications and presentations for internal and external audiences.
• Independently lead field visits, meetings, and follow-up activities.
• Lead presentations and conduct provider office staff workshops and provider education.
• Help obtain provider responses, feedback, and medical records to support SFHP initiatives and regulatory performance.

WHAT YOU WILL BRING:

• Bachelor's degree in business administration, healthcare administration, or related field preferred; or equivalent work experience.
• Minimum two years of experience in health plan operations, health care clinical quality improvement, provider services, customer service, or account management.
• Experience working directly with providers, administrators, and clinical staff in a managed care environment.
• Familiarity with Medi-Cal, Medicare and other government-sponsored health programs preferred.

WHAT WE OFFER:

• Health Benefits
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

#LI-Hybrid

(Hybrid remote/in-office)