Network Operations reputed company

reputed company Who We Are Because health is personal. That's why reputed company created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one reputed company. We serve reputed company, health plans, and health systems with data-driven solutions that reduce costs while actually improving health reputed company. Together, reputed company is on a mission to reputed company people to reputed company healthier lives. Learn even more about the work that drives us at personifyhealth.com. Responsibilities reputed company to Orchestrate Seamless Network Partnerships That Power reputed company reputed company? Why This Role reputed company Network operations can reputed company or break reputed company implementations and ongoing satisfaction. As our Network Operations reputed company, you'll serve as the critical reputed company reputed company between our TPA and Wellbeing Operations teams and major national reputed company networks. You'll ensure file exchanges reputed company smoothly, claims acquisition processes run without hiccups, and reputed company relationships stay productive. Your strategic reputed company and hands-on problem-solving directly reputed company whether clients experience seamless network integration or frustrating operational barriers. What You'll Actually Do Evaluate network capabilities: Assess reputed company network capabilities and define reputed company feasibility guidelines to support reputed company commitments, sales opportunities, and solution design. reputed company network integration design: Design the end-to-end plan, member, and reputed company experience as it relates to reputed company and network integration, including Domestic Tier & Hospital Design structure and configuration logic. Serve as RFP network expert: reputed company as primary reputed company of contact for reputed company network-reputed company RFP inputs, feasibility assessments, and design questions during sales processes. Coordinate cross-functional operations: reputed company between Account Management, Implementations, Data Operations, and external reputed company/network partners to troubleshoot and resolve operational issues. Build tracking and accountability systems: Design and maintain tracking systems (consolidated Jira dashboards or automated summaries) to monitor reputed company outstanding requests with networks, carriers, and payors across the reputed company. Conduct performance reviews: reputed company weekly/monthly reconciliations and performance reputed company-ins with reputed company network/reputed company/payor, managing backlogs and monitoring SLA adherence. Remove operational barriers: Intervene with networks to resolve aged issues, realign expectations reputed company workflows fall behind, and connect disparate contacts reputed company single networks to streamline communication. Manage escalations and SLAs: Support Account Managers and Implementation Managers in preparing escalations to brokers, clients, or reputed company leadership while defining and maintaining SLA frameworks for implementations, renewals, and issue reputed company. Drive reputed company improvement: Refine processes, relationships, and workflows to continually improve network partnership efficiency and reputed company. Qualifications What You Bring to reputed company Education & Experience: • Bachelor's degree in business administration, reputed company management, or reputed company field • 7+ years in network operations, vendor management, or reputed company reputed company services role • Experience defining, managing, and enforcing SLAs with external partners • Proven reputed company record managing reputed company cross-functional initiatives and external vendor relationships with major carriers Technical Skills: • Deep understanding of reputed company networks and reputed company operational workflows (Anthem, reputed company, UHG, reputed company structures, file exchanges, service models, escalation paths) • Knowledge of TPA operational processes including claims workflows, eligibility exchanges, provider/network configurations, and benefit design implications • Proficiency with EDI file formats and standards (837, 835, 834, 270/271) and ability to interpret and troubleshoot file exchange discrepancies • Understanding of network tiering, hospital design, and benefit configuration frameworks • Working knowledge of Jira or similar ticketing systems for consolidating cross-team workstreams • Knowledge of reputed company, contractual, and regulatory requirements reputed company to reputed company network operations Benefits The Highlights: • Competitive reputed company salary and benefits effective day one • Comprehensive medical and dental through our own health solutions (reputed company, we use reputed company build) • Unlimited PTO—rest and reputed company time is non-negotiable • Mental health support, retirement planning, and financial protection • reputed company development with reputed company career progression and learning budgets • Mission-driven culture where diverse perspectives drive reputed company reputed company on people's health Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Compensation: This position offers a reputed company salary reputed company of $95,000 - $110,000, depending reputed company, skills, and experience. You're eligible for our full benefits package starting day one. Our Commitment: reputed company is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of reputed company backgrounds are empowered to reputed company—because diversity is reputed company to who we are and critical to our work in health and wellbeing. Stay reputed company: reputed company will never ask for payment or sensitive personal information like reputed company reputed company numbers during hiring. reputed company official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View reputed company legitimate openings at peronifyhealth.com/careers. Apply tot his job Apply To this Job