{"id":4315647,"url":"https://alion.io/job/pplsi-provider-relations-credentialing","title":"Provider Relations Credentialing","company":{"id":3089127,"name":"Pplsi","domain":"pplsi.com","url":"https://alion.io/company/pplsi","size_band":null,"is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":null},"role":"Legal","role_family":"Legal","seniority":"middle","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"posting_text","remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":27956,"max":37411,"currency":"USD","period":"year","gross":null,"usd_annual":37411},"salary_estimate":null,"experience_years_min":3,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Office","optional":false}],"status":"live","first_seen_at":"2026-11-13T00:00:00Z","employer_posted_date":"2026-11-13","last_verified_at":"2026-11-14T15:48:14Z","board_verified":true,"closed_at":null,"days_open":1,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":1},"description":"Job Summary:\nAs a Credentialing Representative, your primary responsibility is to oversee and manage the credentialing process within CLC’s organization. You will be maintaining all provider files (attorney and mediators), contracted and non-contracted in accordance with company policy, and maintaining contact and responding to provider inquiries. Your attention to detail and adherence to regulatory guidelines will play a crucial role in maintaining compliance and upholding the organization's reputation.Responsibilities:\nScope of the Role\nUnder minimal supervision, you will be responsible for collecting and reviewing credential applications, verifying the accuracy and completeness of the information provided. You will validate the licensing of network providers through local and state agencies to confirm that providers meet the required standards.\nContinuous quality assurance and performance improvement are important aspects of the role. You will participate in quality assurance activities related to credentialing and identify opportunities for process enhancements. Regular audits and quality checks will be conducted to ensure the accuracy and integrity of data.\nCredential representative supports the company’s mission to provide high-quality customer service to members, providers, and potential customers. This includes outbound calling, receiving inbound calls, and email communications to providers.\nPerformance Outcomes\nCredentialing Process Management\nCollect and review credential applications for completeness and accuracy. \nEnsure all required documents, such as education, training, licensure, and certifications, are obtained and verified. \nMaintain a thorough understanding of regulatory requirements, accrediting standards, and internal policies related to credentialing. \nManage the initial and re-credentialing processes for all network providers. \nKeep track of deadlines and ensure timely completion of the credentialing process. \nVerification and Evaluation\nVerify the credentials for the accuracy of information provided by network providers including education, training, certifications, and licenses, through primary sources. \nConducting thorough background to local state bar agencies. \nEvaluate network healthcare provider credentials to ensure they meet the required standards and qualifications. \nAssess and address any discrepancies or issues that arise during the credential process. \nDocument and maintain records of verification outcomes. \nCompliance and Database Management\nEnsure compliance with applicable regulatory requirements and accrediting standards. \nStay updated with changes in regulations and standards and make necessary adjustments to the credentialing process. \nMaintain accurate and up-to-date records of network providers in a credential database. d. Enter and update information related to credentials, licenses, certifications, and other relevant details. \nGenerate reports on credentialing status, expirations, and upcoming re-credentialing activities. \nCollaborate with internal and external stakeholders to address and resolve any compliance issues. \nEducation, Knowledge, and Experience\n3 years of experience in customer service, preferably in sales environment preferred \nHigh School diploma or equivalent required \nStrong computer knowledge; proficiency in Microsoft Office applications \nTypes a minimum of 35 WPM \nCompassionate, courteous, and concise communication skills \nExcellent writing skills \nAbility to educate our customers effectively and accurately on products and services \nExcellent telephone etiquette \nDetail-oriented and strong organizational skills \nStrong computer knowledge; proficiency in Microsoft Office applications \nAbility to multi-task with multiple assigned contracts \nAccurately able to retain and document copious amounts of information \nFLSA Status\nNon Exempt\nPhysical Requirements/ Work Environment\nThe work environment characteristics and physical demands described here are representative of these an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.\nMaintain excellent attendance and adherence \nAble to retain copious amounts of information as it relates to the customer’s issue, the customer's benefits, and limitations. \nProlonged periods of sitting or standing at a desk and working on a computer. \nMust be able to regularly lift and carry and otherwise move up to 15 pounds at times and occasionally up to 30 pounds. \nThe ability to frequently physically move between departments/floors. \nWhile performing the duties of this job, the employee is regularly required to use hands free and fingers to handle, feel, or operate objects, tools, or controls, and reach with hands and arms. \nAdditional Information:\nLocation: Remote - United States \nWork Arrangement: This position is fully remote. Occasional travel to corporate offices or company events may be required based on business needs.\nEmployment Type: Full-time\nFLSA: Non-exempt\nApplication deadline: This posting is anticipated to close on 12/15/2026\nCompensation: $27,956 - $37,411 annually\nBenefits:\nLegalShield offers eligible employees a comprehensive benefits package that includes medical, dental, and vision coverage; company-paid short-term disability and basic life and AD&D insurance; a 401(k) retirement plan with company match; paid time off, paid holidays, paid sick leave, and paid parental leave; and LegalShield and IDShield membership plans. Additional benefits may apply based on position and eligibility.\nOther Compensation:\nIn addition to base pay, this position is eligible for an annual OR quarterly bonus which is a percentage of base salary and based on company and individual performance. Incentive awards are discretionary and are not guaranteed.\nLocation:\nRemote Job PostingDepartment:\n9372-1 Legal ServicesTime Type:\nFull timeCommitment to Equal Opportunity\nPPLSI conforms to all the laws, statutes, and regulations concerning equal employment opportunities. We strongly encourage women, minorities, individuals with disabilities and veterans to apply to all of our job openings. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, status as a protected veteran, and basis of disability or any other federal, state or local protected class. We prohibit retaliation against individuals who bring forth any concerns, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any concerns or otherwise oppose discrimination.\nIf you require a reasonable accommodation to complete the application process, please contact Human Resources at: .","description_format":"text","description_chars":6943,"description_truncated":false,"requirements":{"experience_years_min":3,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"high_school","optional":false},"security_clearance":false,"languages":[]},"benefits":["Company events","Parental leave","Retirement plans"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Legal Services"],"lifecycle":[{"event":"open","at":"2026-11-14T15:48:14Z"}],"visa":[],"liveness":{"score":86,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.86,"p_room":1,"age_days":1,"expected_fill_days":24,"reasons":["conf:0","win:early"],"computed_at":"2026-11-14T16:19:18Z"},"pay":{"stated_usd_annual":37411,"is_top_pay":false},"html_url":"https://alion.io/job/pplsi-provider-relations-credentialing","json_url":"https://alion.io/job/pplsi-provider-relations-credentialing.json","meta":{"generated_at":"2026-11-14T16:19:18Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":18423,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-11-15T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.1,"usd":0.01,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":3089127},"rest":"https://alion.io/mcp/rest/get_company?id=3089127"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fpplsi-provider-relations-credentialing"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"free","price":{"credits":0,"usd":0},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fpplsi-provider-relations-credentialing"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.1,"usd":0.01},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fpplsi-provider-relations-credentialing"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/pplsi-provider-relations-credentialing\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fpplsi-provider-relations-credentialing"}],"agent":{"mcp":"https://alion.io/mcp/jobs","mcp_open":"https://alion.io/mcp/open","next":[{"tool":"get_job","arguments":{"id":4315647}},{"tool":"search_jobs","arguments":{"company":"pplsi.com","detail":"compact"}},{"tool":"match_people","arguments":{"job_id":4315647},"note":"people open to offers who fit this vacancy"}],"note":"The same data through MCP tools: https://alion.io/mcp/open needs no sign-in (compact searches, postings, people); https://alion.io/mcp with an Alion account has everything. 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