Network Operations Coordinator

Minnesota, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

High school diploma or equivalent is required, along with at least one year of prior experience in an administrative, customer support, or healthcare role. Candidates must possess intermediate Microsoft Word and Excel skills, the ability to work in a deadline-driven environment, strong attention to detail, and demonstrated ability to articulate ideas effectively both verbally and in writing. Prior experience in the healthcare insurance industry, claims processing, or contract interpretation is preferred.

Responsibilities

The Network Operations Coordinator maintains provider relations to support customer service activities by managing data integrity and gathering provider claims data. They are responsible for managing provider data for health plans, including demographics, rates, and contract intent. This role also involves managing provider audits, service relations, credentialing, and contract management systems, as well as executing intake processes and managing provider-perceived service failures. The coordinator exercises discretion and judgment in prioritizing requests and adapting procedures.

Skills

Data Integrity Management

Provider Data Management

Claims Data

Demographics

Rates

Contract Management

Provider Audits

Provider Service

Provider Relations

Credentialing

Microsoft Word

Microsoft Excel

Deadline Driven Environment

Attention to Detail

Written Communication

Oral Communication

Healthcare Insurance

Claims Processing

Contract Interpretation

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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