Network Operations Professional

Employment Type: Full-time

Position Overview

Humana Healthy Horizons is seeking a Network Operations Professional to join our caring community. This role focuses on maintaining provider relations to support customer service activities through data integrity management and gathering provider claims data essential for service operations. The Network Operations Professional will handle varied work assignments that frequently require interpretation and independent determination of appropriate courses of action.

Responsibilities

• Manages provider data for health plans, including 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.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed.
• Follows established guidelines/procedures.

Required Qualifications

• Must work within the Eastern Standard Time zone hours.
• 3+ years of provider network experience.
• Demonstrated expertise in financial modeling, data preparation, and analysis using Excel, Access, and other Microsoft applications.
• Experience using Structured Query Language (SQL).
• Prior experience managing mid to large-scale projects.
• Strong attention to detail.

Work at Home Requirements

• A minimum download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.
• Wireless, wired cable, or DSL connection is suggested.
• Satellite, cellular, and microwave connections can be used only if approved by leadership.
• Humana will provide telephone equipment appropriate to meet business requirements for remote associates.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Bachelor's degree.
• Service Fund experience.
• PMP or PMI-ACP certifications.
• Previous experience in the health solutions industry working with large data sets and health-care data.
• Experience with SAS and/or SPSS.
• Intermediate to advanced experience in programming, analytical work, research, and/or statistics.

Additional Information

• Workstyle: Remote, work at home.
• Travel: None.
• Core Workdays & Hours: Typically, Monday – Friday 8:00 am – 5:00 pm Eastern Standard Time.
• Benefits: Benefits are effective on day 1. Full-time Associates enjoy competitive pay and a comprehensive benefits package including 401k, Medical, Dental, Vision, a variety of supplemental insurances, tuition assistance, and more.

Interview Format

As part of our hiring process, we will be using interviewing technology provided by HireVue. If selected to move forward, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.

• Pre-recorded Voice Interview: Respond to interview questions via your phone. Expect this to take approximately 10-15 minutes.
• SMS Text Interview: Answer a series of questions using your cell phone or computer. Expect this to last anywhere from 5-10 minutes.

Your recorded interview(s) will be reviewed, and you will be informed if you will be moving forward to the next round of interviews.