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Humana logo
Humana

Louisville, Kentucky-based Humana is a leading healthcare company that offers a variety of health, wellness, and insurance products and services designed to off

Provider Network Operations

Location

California + 3 moreAll locations: California | Illinois | Montana | South Dakota

Posted

34 days ago

Salary

$59.3K - $80.9K / year

Seniority

Senior

Bachelor Degree3 yrs expEnglishPMPSQL

Job Description

Provider Network Operations

Humana

• Maintain provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. • Manage provider data for health plans including demographics, rates, and contract intent. • Manage provider audits, provider service and relations, credentialing, and contract management systems. • Execute processes for intake and manage provider perceived service failures. • Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. • Follow established guidelines/procedures.

Job Requirements

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

Benefits

  • Health benefits effective day 1
  • Paid time off, holidays, volunteer time and jury duty pay
  • Recognition pay
  • 401(k) retirement savings plan with employer match
  • Tuition assistance
  • Scholarships for eligible dependents
  • Parental and caregiver leave
  • Employee charity matching program
  • Network Resource Groups (NRGs)
  • Career development opportunities

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