Network Management Consultant

🕒 2 days ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $55.9k - $123.5k / year

⏰ Full Time

🟢 Junior

💼 Consultant

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Health Care Service Corporation serves nearly 23 million people across the United States through its portfolio of health benefit solutions.

📋 Description

• Handle a caseload of both informal and formal disputes involving out-of-network providers under Texas Senate Bill 1264 (SB 1264). • Independently evaluate reimbursement disputes, apply applicable regulatory guidelines, and facilitate resolution through structured negotiation and case management. • Ensure timely, accurate, and compliant resolution of assigned cases while maintaining effective communication with internal and external stakeholders. • Play a key role in driving consistent case outcomes and operational efficiency within a high-volume regulatory environment.

🎯 Requirements

• Bachelor Degree and at least one year experience developing and negotiating provider contracts OR 5 years managed care operations experience handling independent work with at least one year experience developing and negotiating provider contracts. • Meet deadlines and work well under pressure. • Verbal and written communication skills, organizational and planning skills. • PC proficiency to include Microsoft Office. • Analytical skills. • Ability and willingness to travel within assigned territory, including overnight stays. • Experience with Excel, specializing in Vlook ups & Pivot Tables. • Knowledgeable of the TX SB1264 Law. • Effective time management skills.

🏖️ Benefits

• Health and wellness benefits • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement