Network Operations Coordinator 4 / Auditor

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first. The Network Operations Coordinator 4 / Auditor maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations.

Responsibilities

• Manages provider data including but not limited to demographics, rates, and contract intent.
• Manages provider audits, provider service and relations, credentialing, and contract management systems.
• Executes processes for intake and manages provider perceived service failures.
• Audits provider data: demographic, contract, service fund.
• Submission for audit findings into APEX.
• Phone and email communication with providers and contractors.
• Use your skills to make an impact.

Requirements

• Required Qualifications:
  • 2 or more years of provider relations experience.
  • 1 or more years of working experience with APEX, PAAG, and PMDM.
  • Intermediate experience with Microsoft Word.
  • Intermediate experience with Excel (pivot tables, formatting, v-lookup).
  • Must work EST hours.
• Preferred Qualifications:
  • Experience with provider contracts and/or maintaining provider data.
  • Provider contract interpretation experience.
  • Previous account management and/or project management experience.
  • Working experience with medical claims.
  • Ability to work independently and manage workload.

Work Environment & Schedule

• Department Hours: 8 am to 5 pm EST.
• Location: Remote/Work at Home.
• Hours: Full-time, 40 hours per week.
• Work Hours: Must be willing and able to work EST hours.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• Recommended: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps.
• Suggested Connection Types: Wireless, wired cable, or DSL connection.
• Satellite, cellular, and microwave connections can be used only if approved by leadership.
• Internet Expense Reimbursement: Associates who live and work from Home in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Equipment: Humana will provide telephone equipment appropriate to meet the business requirements for the position.
• Workspace: Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Compensation & Benefits

• Pay Range: $53,100 - $72,500 per year.
  • Note: This is a good faith estimate. Actual pay may vary based on geographic location, demonstrated skills, knowledge, experience, education, and certifications.
• Benefits: Humana offers competitive benefits that support whole-person well-being, including:
  • Medical, dental, and vision benefits.
  • 401(k) retirement savings plan.
  • Time off (paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave).
  • Short-term and long-term disability.
  • Life insurance.
  • Many other opportunities.

Company Information

• About Us: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company.
• Internal Inquiries: If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number. #LI-BB1

Application Deadline

• 07-31-2025