Network Management Rep

The Network Management Rep provides comprehensive services to the provider community through researching more complex provider issues. How You Will Make An Impact:

• Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.
• Researches and resolves the complex provider issues and appeals for prompt resolution.
• Captures and coordinates prompt claims resolution through direct contact with providers and claims department.
• Might perform periodic provider on-site visits.
• Provides assistance with policy interpretation.
• Researches, analyzes and recommends resolution of provider disputes, issues with billing, and other practices.
• Aids providers with provider demographic changes as appropriate.
• Responds to provider issues related to billing, pricing, policy, systems and reimbursements.
• Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
• Determines if providers were paid according to contracted terms.

About the role

This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Responsibilities

• Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.
• Researches and resolves the complex provider issues and appeals for prompt resolution.
• Captures and coordinates prompt claims resolution through direct contact with providers and claims department.
• Might perform periodic provider on-site visits.
• Provides assistance with policy interpretation.
• Researches, analyzes and recommends resolution of provider disputes, issues with billing, and other practices.
• Aids providers with provider demographic changes as appropriate.
• Responds to provider issues related to billing, pricing, policy, systems and reimbursements.
• Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
• Determines if providers were paid according to contracted terms.

Requirements

• Requires a H.S. diploma or equivalent and a minimum of 3 years of customer service experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, And Experiences

• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.

Benefits

This role offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution. The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.

Pay

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.

Schedule

This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Qualifications

• Requires a H.S. diploma or equivalent and a minimum of 3 years of customer service experience; or any combination of education and experience, which would provide an equivalent background.

Skills

• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

• We are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
• Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Equal Employment Opportunity

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.