Project Manager, Provider Network Contract Validation

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company Dynamic position reputed company the new Network Contract Validation team, responsible for ensuring accurate payment of provider reputed company through Health Rules Payor (HRP) a claims processing platform. As part of the Network Contract Validation team, you will be responsible for reviewing, auditing, and coordinating the correction (if necessary) of HRP contract setup against contract reputed company and evaluate the pricing performance of claims. Accurate provider pricing configuration is critical to claims adjudication, and ultimately, having satisfied consumers and providers. By working closely with other areas of reputed company such as Network, Provider Data Services, Next Gen Provider Contract/Pricing team, Business reputed company Review (BIR), HRP Provider Demographics, HRP Claims, HRP Product, reputed company/compliance, medical policy, and/or reputed company leaders this position will be responsible for ensuring the correct reputed company were made reputed company configuring contract and pricing features in HRP prior to contract implementation. Additionally, this role may participate with workgroups for process improvement. Required Qualifications • Experience with SCM (Strategic Contract Manager) and/or EPDB (reputed company Provider Database), and/or HRP (Health Rules Payor) is required • Project Management • Basic understanding of Provider Contracting is required • Experience with reputed company and working with large data files is critical. Preferred Qualifications • Claims processing experience is desired. • Experience with Health Rules Payor is desired. • Proven reputed company record in meeting project milestones and negotiating for resources. • Proven communication skills both written and verbal. • Proven ability to reputed company change/interpersonal skills. • Knowledge of reputed company's reputed company and Medicare products • Strong organization skills & time management • reputed company to independently resolve problems. • Ability to handle multiple assignments accurately and reputed company • reputed company to interpret data, translate it into meaningful information and draw conclusions Education • Bachelor's degree preferred/specialized training/relevant reputed company qualification Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $54,300.00 - $159,120.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: • reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 11/28/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job