Provider Operation Specialist

• Maintain and update provider data across health plans and lines of business
• Coordinate provider paneling operations and ensure provider listing accuracy
• Serve as a liaison between health plans and internal departments regarding provider network updates and changes
• Create, update, and validate provider network rosters and health plan files
• Support provider network operations, contracting processes, and compliance initiatives
• Conduct audits, monitor compliance, and assist with corrective action planning
• Analyze workflows and recommend process improvements
• Collaborate with internal teams and health plan partners to ensure timely and accurate provider information
• Prepare reports and assist leadership with tracking provider operations metrics

• Bachelor’s degree in Business Administration, Healthcare, Organizational Management, or related experience required
• Prior experience in managed care, provider relations, claims, contracting, or health plan operations preferred
• Experience interacting with multiple health plans strongly preferred
• Knowledge of managed care and provider contracting principles preferred
• Experience using MS Access, SQL databases, or healthcare systems preferred
• Strong communication, organizational, and problem-solving skills, * High school or equivalent (Required), * Health plan: 2 years (Preferred)
• MS Access or SQL databases: 2 years (Preferred)
• Provider contracts: 1 year (Preferred)

Ability to Commute:

• Montebello, CA 90640 (Required)

Pulled from the full job description

• Health insurance
• Vision insurance
• Dental insurance
• Life insurance, This is a great opportunity for someone who enjoys healthcare operations, provider network management, and process improvement within a managed care environment.

Pay: $26.00 - $30.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Vision insurance