Provider relations representative vs customer care representative

The differences between provider relations representatives and customer care representatives can be seen in a few details. Each job has different responsibilities and duties. It typically takes 6-12 months to become both a provider relations representative and a customer care representative. Additionally, a provider relations representative has an average salary of $40,957, which is higher than the $32,912 average annual salary of a customer care representative.

The top three skills for a provider relations representative include customer service, provider relations and medicaid. The most important skills for a customer care representative are customer care, customer service, and work ethic.

Provider relations representative vs customer care representative overview

	Provider Relations Representative	Customer Care Representative
Yearly salary	$40,957	$32,912
Hourly rate	$19.69	$15.82
Growth rate	-4%	-4%
Number of jobs	203,893	214,835
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 58%	Bachelor's Degree, 37%
Average age	40	40
Years of experience	12	12

What does a provider relations representative do?

Provider relations specialists are professionals who work for insurance companies as the primary contact for health care providers such as clinics and hospitals. These specialists are required to provide answers about service contracts and billing procedures to health care providers. They must handle the documents of patients to ensure that proper paperwork has been filed for coverage while developing communications with providers about any policy changes. Provider relations specialists must also travel to different health care organizations to provide training to their staff on insurance policies and procedures.

What does a customer care representative do?

A customer care representative is responsible for providing resolution with the customer's concerns, following the business' procedures and strategic processes. Customer care representatives must have exceptional customer service skills to address their clients' concerns efficiently and accurately, as well as having extensive knowledge of the products and services their company offer. Duties of a customer care representative also include managing client's complaints, offering alternative products and refunds as needed, calculating fees for special requests, updating customer's account information, documenting actions taken, and escalating special case concerns to the supervisor.

Provider relations representative vs customer care representative salary

Provider relations representatives and customer care representatives have different pay scales, as shown below.

	Provider Relations Representative	Customer Care Representative
Average salary	$40,957	$32,912
Salary range	Between $30,000 And $55,000	Between $26,000 And $40,000
Highest paying City	Helena, MT	Urban Honolulu, HI
Highest paying state	Montana	Hawaii
Best paying company	Parkland Hospital	Philadelphia Corporation for Aging
Best paying industry	Health Care	Automotive

Differences between provider relations representative and customer care representative education

There are a few differences between a provider relations representative and a customer care representative in terms of educational background:

	Provider Relations Representative	Customer Care Representative
Most common degree	Bachelor's Degree, 58%	Bachelor's Degree, 37%
Most common major	Business	Business
Most common college	-	-

Provider relations representative vs customer care representative demographics

Here are the differences between provider relations representatives' and customer care representatives' demographics:

	Provider Relations Representative	Customer Care Representative
Average age	40	40
Gender ratio	Male, 24.2% Female, 75.8%	Male, 32.0% Female, 68.0%
Race ratio	Black or African American, 12.1% Unknown, 5.3% Hispanic or Latino, 21.8% Asian, 6.5% White, 53.7% American Indian and Alaska Native, 0.7%	Black or African American, 11.7% Unknown, 5.3% Hispanic or Latino, 20.0% Asian, 6.5% White, 55.8% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between provider relations representative and customer care representative duties and responsibilities

Provider relations representative example responsibilities.

Help manage ACO program and review measures with provider offices.
Advise clients on health care and manage care products including POS, PPO and medical management programs.
Provide keen oversight in developing and maintaining quality improvement programs while managing payroll.
Manage software maintenance renewal partner and assist with upselling additional and higher functionality licenses to increase revenue.
Review the provider contracts, paid members claims, base on the CPT code & ICD-9 that are submitted.
Review provider claims for CPT and ICD-9 coding accuracy and generate payment of claims base upon current fee schedule.

Customer care representative example responsibilities.

Manage and plan escalations; assure HIPPA guidelines are followed for confidentially and privacy.
Answer incoming calls from clients, ATP's, therapists, and medical offices.
Maintain schedules for multiples ATP's and technicians to assist clients with scheduling therapy evaluations, and delivery of equipment.
Design a web-base CRM tool integrate with many other systems to provide technicians one-page panel the most relevant information and actions.
Navigate windows environment and comprehend technical information.
Used multiple navigation windows while changing account information and processing orders.

Provider relations representative vs customer care representative skills

Common provider relations representative skills

Customer Service, 16%
Provider Relations, 9%
Medicaid, 9%
Patients, 6%
Health Plan, 5%
PowerPoint, 4%

Common customer care representative skills

Customer Care, 21%
Customer Service, 9%
Work Ethic, 7%
Strong Work Ethic, 7%
Data Entry, 4%
Excellent Organizational, 4%

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Office and Administrative Industry
Provider Relations Representative
Provider Relations Representative vs Customer Care Representative

Updated January 8, 2025

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