Join Our Caring Community – Help Us Put Health First
Humana Healthy Horizons is seeking a Network Operations Professional to manage provider relations and data integrity in support of customer service operations. This is a remote role focused on enhancing provider data, improving claims processes, and delivering operational excellence within our Medicaid health plans.
Key Responsibilities
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Maintain provider data including demographics, rates, and contract intent.
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Support contract management, credentialing, provider services, and audits.
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Manage provider service issues and perceived service failures.
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Interpret internal strategies and apply them to operational decision-making.
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Make independent decisions and adapt to ambiguous situations.
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Follow established company procedures and protocols.
Required Qualifications
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Must be able to work full-time within Eastern Standard Time (EST).
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Minimum 3+ years of provider network experience.
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Strong experience in Excel, Access, and other Microsoft applications.
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Proficient in SQL and data management.
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Proven experience leading mid- to large-scale projects.
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Detail-oriented with excellent problem-solving skills.
Preferred Qualifications
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Bachelor’s degree in a related field.
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Experience with Service Fund, SAS, or SPSS.
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Certification such as PMP or PMI-ACP.
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Previous experience working with large healthcare datasets.
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Intermediate to advanced knowledge in programming, statistics, or analytical research.
Work at Home Requirements
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Minimum internet speed: 25 Mbps download / 10 Mbps upload.
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Connection type: Wired cable or DSL recommended (satellite/cellular/microwave with leadership approval).
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Must have a dedicated workspace to protect PHI and HIPAA-sensitive information.
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Humana provides necessary phone equipment.
Schedule
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Monday to Friday, 8:00 AM – 5:00 PM EST
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No travel required, although occasional office visits for training/meetings may be requested.
Benefits (Effective Day 1)
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Medical, Dental, Vision insurance
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401(k) retirement plan with company match
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Paid time off, company holidays, and volunteer days
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Parental & caregiver leave, short- and long-term disability
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Life insurance and tuition assistance
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Holistic wellness support and career development resources
Interview Process
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Candidates will participate in a HireVue interview (pre-recorded video or SMS text interview).
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This will take approximately 10–15 minutes for voice or 5–10 minutes for text-based responses.
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Finalists will be contacted for further interviews.
About Humana
Humana Inc. (NYSE: HUM) is a leading health and well-being company focused on helping people achieve their best health. Serving individuals with Medicare, Medicaid, and military families, we provide health insurance and healthcare services nationwide. Through our insurance offerings and CenterWell primary care services, we aim to put health first for every member and community we serve.
Equal Opportunity Statement
Humana is an Equal Opportunity Employer. We make employment decisions without regard to race, religion, color, gender, sexual orientation, gender identity, national origin, age, disability, veteran status, or other legally protected statuses. We comply fully with Section 503 of the Rehabilitation Act and VEVRAA guidelines.
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