Wednesday , September 27 2023

Humana Job Openings – Network Professional

Website Humana

Job Description:

The Network Operations Professional 2 maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Network Operations Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Job Responsibilities:

The Network Operations Professional 2 manages provider data for health plans 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 manage 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, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Job Requirements:

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Demonstrated expertise in financial modeling, data preparation and analysis using Excel, Access and other
  • Microsoft applications
  • Strong Attention to Detail
  • PMP desired

Qualification & Experience:

  • Previous experience in the health solutions industry
  • Prior experience managing mid to large scale projects
  • 3 – 5 years of provider network experience
  • Service Fund experience strongly desired

Job Details:

Company: Humana

Vacancy Type: Full Time

Job Location: Tampa, FL, US

Application Deadline: N/A

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