Provider Network Operations

Provider Network Operations at Humana in Boise, Idaho, United States Job Description Become a part of our caring community Humana Healthy Horizons is looking for a Network Operations Professional who 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 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Network Operations Professional responsibilities include (but not limited to): + Manage provider data for health plans including demographics, rates, and contract intent. + Manages 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. Use your skills to make an impact Required Qualifications + Must work within the eastern standard time zone hours. + 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. Preferred Qualifications + Bachelor's degree. + Service Fund experience. + PMP or PMI-ACP certifications. + Previous experience in the health solutions industry working with large datasets and health-care data. + Experience with SAS and/or SPSS. + Intermediate to advanced experience in programming, analytical work, research and/or statistics.

Additional Information:

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Workstyle:

Remote, work at home. +

Travel:

None. +

Core Workdays & Hours:

Typically, Monday - Friday 8:00am - 5:00pm Eastern Standard Time. +

Benefits:

Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more….. WAH Internet Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed o

Job Posting:

JC291686983

Posted On:

May 13, 2026

Updated On:

May 13, 2026