Network Operations Professional 1

Become a part of our caring community and help us put health first

The Network Operations Professional 1 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 1 work assignments are often straightforward and of moderate complexity.

The Network Operations Professional 1 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 own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree

• Must be fully bilingual English/Spanish

• 3 years of Provider contracting provider relations or provider operations

• Experience working in a matrix reporting environment

• Previous experience in claims

• Prior contract interpretation experience

• Superior organizational skills

• Ability to work in a deadline driven environment

• Experience facilitating meetings

• Experience in Microsoft Word, Excel and PowerPoint

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• This is an in the office position

• Office Location: 383 Ave FD Roosevelt, San Juan, PR 00918

Preferred Qualifications

• Advanced Degree

• Demonstrated experience with process documentation

• Prior experience with supporting other complex projects

• Proficiency in MS Access

• Experience in managed care or health care administration desired

• Knowledge of CAS, CRM, APEX

Additional Information

Humana Perks:

Full time associates enjoy:

• Medical, Dental, Vision and a variety of other supplemental insurances

• Paid time off (PTO) & Paid Holidays

• 401(k) retirement savings plan with a competitive match

• Tuition reimbursement and/or scholarships for qualifying dependent children

• And much more!

Social Security Task:

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Virtual Pre-Screen:

As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a Modern Hire interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$35,800 - $49,300 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.