The Network Operations Professional 2 analyzes, manages and sustains relationships with local contracted provider organizations. This role serves as a provider relations resource and liaison between provider organizations and Humana’s Provider Process and Service operational teams. This position requires on site collaboration with provider organizations to ensure market service operational excellence regarding claim disputes and effective resolution. In addition, this role is involved in tracking, communicating and resolving data integrity management when necessary. The Network Operations Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Network Operations Professional 2 uses best business practices within and outside the organization to ensure provider claims disputes are appropriately resolved in accordance with the Provider Process and Service operational team practices. Manages defined provider Service Operational Committees and tracks provider dispute resolution to successful completion. Possesses strong communication skills and ability to discuss all aspects of network operations and explain anything that is unclear. Listens carefully to provider concerns and utilizes excellent interpersonal skills to build rapport. 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.
Required Qualifications• High school diploma or equivalent• 3- 5 years of provider organizational experience• 3 - 5 years medical claims processing operations experience or similar medical claims provider relations knowledge• Demonstrated expertise in analysis using Excel, Access and other Microsoft applications• Prior experience managing mid to large scale projects• Strong attention to detail• Ability to travel up to 25% of the time to the Denver, Phoenix and New Mexico offices
Preferred Qualifications• Bachelor's degree • PMP desired
Additional InformationInterview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
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