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Senior Network Performance Professional
23274 Richmond, Virginia
Humana
Posted 2 days ago
Job Viewed
Job Description
**Become a part of our caring community and help us put health first**
As a Senior Network Performance Professional at Humana, you will play a pivotal role in enhancing provider performance within the SouthEast Region and advancing Humana's mission to deliver high-quality healthcare. You will work with providers to improve their STARs ratings and overall performance through strategic initiatives and strong relationship-building.
Key Responsibilities
+ Works with SouthEast Region providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
+ Recommends execution strategies and monitor performance toward these goals
+ Actively monitors and analyzes provider performance data to identify areas for improvement
+ Serves as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience
+ Collaborates to develop tailored action plans and communicate actionable insights to improve performance
+ Implements strategies to enhance outcomes and provide ongoing support and guidance to providers
+ Acts as a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools
+ Facilitates communication between providers and internal teams to ensure seamless access to necessary resources and support
+ Educates provider groups on reward programs and target metrics, collaborating to achieve established goals
+ Monitors and reports on the effectiveness of reward programs, making recommendations for enhancements as needed
+ Resolves provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers
+ Implements strategies to minimize provider abrasion and enhance overall satisfaction
+ Partners with internal teams to track and report on market performance, ensuring alignment with organizational goals
+ Collaborates with cross-functional teams to drive initiatives that support provider performance improvement
In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:
+ Medical Benefits
+ Dental Benefits
+ Vision Benefits
+ Health Savings Accounts
+ Flex Spending Accounts
+ Life Insurance
+ 401(k)
+ PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
+ And more
**Use your skills to make an impact**
**Required Qualifications**
+ 3+ years experience with Medicare and/or managed care
+ Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
+ Experience building relationships with physician groups and influencing execution of recommended strategy
+ Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint
+ Experience presenting to internal and external customers, including high-level leadership
+ Strong communication skills, both verbal and written
+ **Must be able to work during 8-5pm (Eastern)**
+ **Willingness to travel a minimum of 10%**
**Preferred Qualifications**
+ Bachelor's Degree or Master's Degree in Business, Finance, Health Care/Administration, RN or a related field
+ Experience with Medicare Risk Adjustment
+ Progressive experience with interoperability solutions in Healthcare
+ Proven organizational and prioritization skills and ability to collaborate with multiple departments
**Additional Information**
Work at Home/Remote Requirements
**Work-At-Home Requirements**
+ To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
+ Wireless, Wired Cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
+ Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
**Our Hiring Process**
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging, and/or Video Interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone or computer. You should anticipate this interview to take approximately 10-15 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
#LI-LM1
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our
As a Senior Network Performance Professional at Humana, you will play a pivotal role in enhancing provider performance within the SouthEast Region and advancing Humana's mission to deliver high-quality healthcare. You will work with providers to improve their STARs ratings and overall performance through strategic initiatives and strong relationship-building.
Key Responsibilities
+ Works with SouthEast Region providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
+ Recommends execution strategies and monitor performance toward these goals
+ Actively monitors and analyzes provider performance data to identify areas for improvement
+ Serves as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience
+ Collaborates to develop tailored action plans and communicate actionable insights to improve performance
+ Implements strategies to enhance outcomes and provide ongoing support and guidance to providers
+ Acts as a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools
+ Facilitates communication between providers and internal teams to ensure seamless access to necessary resources and support
+ Educates provider groups on reward programs and target metrics, collaborating to achieve established goals
+ Monitors and reports on the effectiveness of reward programs, making recommendations for enhancements as needed
+ Resolves provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers
+ Implements strategies to minimize provider abrasion and enhance overall satisfaction
+ Partners with internal teams to track and report on market performance, ensuring alignment with organizational goals
+ Collaborates with cross-functional teams to drive initiatives that support provider performance improvement
In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:
+ Medical Benefits
+ Dental Benefits
+ Vision Benefits
+ Health Savings Accounts
+ Flex Spending Accounts
+ Life Insurance
+ 401(k)
+ PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
+ And more
**Use your skills to make an impact**
**Required Qualifications**
+ 3+ years experience with Medicare and/or managed care
+ Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
+ Experience building relationships with physician groups and influencing execution of recommended strategy
+ Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint
+ Experience presenting to internal and external customers, including high-level leadership
+ Strong communication skills, both verbal and written
+ **Must be able to work during 8-5pm (Eastern)**
+ **Willingness to travel a minimum of 10%**
**Preferred Qualifications**
+ Bachelor's Degree or Master's Degree in Business, Finance, Health Care/Administration, RN or a related field
+ Experience with Medicare Risk Adjustment
+ Progressive experience with interoperability solutions in Healthcare
+ Proven organizational and prioritization skills and ability to collaborate with multiple departments
**Additional Information**
Work at Home/Remote Requirements
**Work-At-Home Requirements**
+ To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
+ Wireless, Wired Cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
+ Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
**Our Hiring Process**
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging, and/or Video Interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone or computer. You should anticipate this interview to take approximately 10-15 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
#LI-LM1
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our
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0
Network Specialist
96782 Pearl City, Hawaii
Transdev
Posted 4 days ago
Job Viewed
Job Description
Network Specialist
The Network Specialist works in support of the goals of the Network Operations and establishes
positive and effective working relationships with transportation providers and other related agencies to establish superior partnerships between Transdev Health Solutions and the Transportation Provider Network. The Network Specialist provides support to new providers acclimating to Transdev Health Solutions' processes and serves as a resource for existing providers. This position is remote supporting the Ohana, HI contract.
+ Competitive starting pay of $18.00 - $19.00 per hour
Benefits include:
+ Vacation: minimum of two (2) weeks
+ Sick days: 5 days
+ Holidays: 7 days
+ Other standard benefits: 401(k) retirement plan, medical, dental and vision, life insurance, short-term disability, voluntary long-term disability.
Benefits may vary depending on location policy. The above represents the standard Corporate Policy.
Key Responsibilities:
+ Assist with recruiting and onboarding new transportation providers
+ Assist dispatch with identifying providers on trips in which no provider is available
+ Develops and maintains positive working relations with the Provider Network
+ Respond to emails, phone calls and written requests from transportation providers and internal customers while providing consistent and accurate information
+ Host monthly Transportation Provider meetings
+ Ensures all transportation provider complaints are tracked, investigated, and resolved within specified timeframes
+ Train providers on Transdev Health Solution's policies, procedures, and processes
+ Responsible for coaching/counseling providers to enforce policies and procedures and overall performance
+ Perform additional duties and responsibilities as needed and/or assigned
Qualifications:
+ High School Diploma or General Education Degree (GED) required.
+ Two years related experience and/or training preferred
+ Must be professional and customer service oriented with the ability to provide exceptional customer service via phone and email.
+ Ability to proficiently operate a computer and Microsoft Word, PowerPoint, and Excel, Teams, and Outlook proficiency.
+ Ability to remain organized and pay close attention to detail.
+ Ability to accurately conduct primary and secondary research.
+ Ability to read and comprehend instructions, short correspondence, and memos.
+ Ability to write correspondence and effectively present information.
+ Ability to effectively prioritize multiple tasks and deadlines.
+ Ability to complete assignments with minimal supervision and direction.
Requirements:
+ Reliable, high-speed internet connection.
+ Able to work remotely with no interruptions.
+ Must be able to work flexible hours and accommodate advanced-notice schedule changes.
+ Must pass a pre-employment drug test and background check.
+ Must provide a complete and verifiable employment history.
Physical Requirements:
+ Must be able to work shifts or flexible work schedules as needed.
+ The employee is generally subjected to long periods spent sitting, typing, or looking at a computer screen.
+ Work environment may be a combination of both indoors and outdoors.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Transdev complies with federal and state disability laws and makes reasonable accommodations for applicants and candidates with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, please contact
Drug-free workplace:
Transdev maintains a drug-free workplace. Applicants must:
+ Be eligible to work in the United States without requiring sponsorship now or in the future (if based in the U.S.).
+ Successfully pass a pre-employment drug screen.
About Transdev: Cities, counties, airports, companies, and universities across the U.S. contract with Transdev to operate their transportation systems, maintain their vehicle and fleets, and deliver on mobility solutions. Transdev U.S. employs a team of 32,000 across 400 locations while maintaining more than 17,000 vehicles.
Part of a global company, Transdev is a leader in mobility with operations in 19 countries, proudly operated by 110,000 team members from around the world. As an operator and global integrator of mobility, we are driven by our purpose. Transdev - the mobility company - empowers the freedom to move every day thanks to safe, reliable, and innovative solutions that serve the common good. Find out more at or watch an overview video at above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.
Transdev is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, national origin, age, disability, veteran status, genetic data, gender identity, sexual orientation, religion or other legally protected status.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.
California applicants: Please Click Here for CA Employee Privacy Policy.
Job Category: Administrative / Clerical / Payroll / HR / Accounting
Job Type: Full Time
Req ID: 5530
Pay Group: CDB
Cost Center: 403
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.
Transdev is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, national origin, age, disability, veteran status, genetic data, gender identity, sexual orientation, religion or other legally protected status, or any other classification protected by federal, state, or local law.
Drug-free workplace
If based in the United States, applicants must be eligible to work in U.S. without restrictions for any employer at any time; be able to pass a drug screen and background check.
California applicants: Please Click Here for CA Employee Privacy Policy.
About Transdev
Cities, counties, airports, companies, and universities across the U.S. contract with Transdev to operate their transportation systems, maintain their vehicle and fleets, and deliver on mobility solutions. Transdev U.S. employs a team of 32,000 across 400 locations while maintaining more than 17,000 vehicles.
Part of a global company, Transdev is a leader in mobility with operations in 19 countries, proudly operated by 110,000 team members from around the world. As an operator and global integrator of mobility, we are driven by our purpose. Transdev - the mobility company - empowers the freedom to move every day thank to safe, reliable, and innovative solutions that serve the common good. Find out more at or watch an overview video.
The Network Specialist works in support of the goals of the Network Operations and establishes
positive and effective working relationships with transportation providers and other related agencies to establish superior partnerships between Transdev Health Solutions and the Transportation Provider Network. The Network Specialist provides support to new providers acclimating to Transdev Health Solutions' processes and serves as a resource for existing providers. This position is remote supporting the Ohana, HI contract.
+ Competitive starting pay of $18.00 - $19.00 per hour
Benefits include:
+ Vacation: minimum of two (2) weeks
+ Sick days: 5 days
+ Holidays: 7 days
+ Other standard benefits: 401(k) retirement plan, medical, dental and vision, life insurance, short-term disability, voluntary long-term disability.
Benefits may vary depending on location policy. The above represents the standard Corporate Policy.
Key Responsibilities:
+ Assist with recruiting and onboarding new transportation providers
+ Assist dispatch with identifying providers on trips in which no provider is available
+ Develops and maintains positive working relations with the Provider Network
+ Respond to emails, phone calls and written requests from transportation providers and internal customers while providing consistent and accurate information
+ Host monthly Transportation Provider meetings
+ Ensures all transportation provider complaints are tracked, investigated, and resolved within specified timeframes
+ Train providers on Transdev Health Solution's policies, procedures, and processes
+ Responsible for coaching/counseling providers to enforce policies and procedures and overall performance
+ Perform additional duties and responsibilities as needed and/or assigned
Qualifications:
+ High School Diploma or General Education Degree (GED) required.
+ Two years related experience and/or training preferred
+ Must be professional and customer service oriented with the ability to provide exceptional customer service via phone and email.
+ Ability to proficiently operate a computer and Microsoft Word, PowerPoint, and Excel, Teams, and Outlook proficiency.
+ Ability to remain organized and pay close attention to detail.
+ Ability to accurately conduct primary and secondary research.
+ Ability to read and comprehend instructions, short correspondence, and memos.
+ Ability to write correspondence and effectively present information.
+ Ability to effectively prioritize multiple tasks and deadlines.
+ Ability to complete assignments with minimal supervision and direction.
Requirements:
+ Reliable, high-speed internet connection.
+ Able to work remotely with no interruptions.
+ Must be able to work flexible hours and accommodate advanced-notice schedule changes.
+ Must pass a pre-employment drug test and background check.
+ Must provide a complete and verifiable employment history.
Physical Requirements:
+ Must be able to work shifts or flexible work schedules as needed.
+ The employee is generally subjected to long periods spent sitting, typing, or looking at a computer screen.
+ Work environment may be a combination of both indoors and outdoors.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Transdev complies with federal and state disability laws and makes reasonable accommodations for applicants and candidates with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, please contact
Drug-free workplace:
Transdev maintains a drug-free workplace. Applicants must:
+ Be eligible to work in the United States without requiring sponsorship now or in the future (if based in the U.S.).
+ Successfully pass a pre-employment drug screen.
About Transdev: Cities, counties, airports, companies, and universities across the U.S. contract with Transdev to operate their transportation systems, maintain their vehicle and fleets, and deliver on mobility solutions. Transdev U.S. employs a team of 32,000 across 400 locations while maintaining more than 17,000 vehicles.
Part of a global company, Transdev is a leader in mobility with operations in 19 countries, proudly operated by 110,000 team members from around the world. As an operator and global integrator of mobility, we are driven by our purpose. Transdev - the mobility company - empowers the freedom to move every day thanks to safe, reliable, and innovative solutions that serve the common good. Find out more at or watch an overview video at above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.
Transdev is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, national origin, age, disability, veteran status, genetic data, gender identity, sexual orientation, religion or other legally protected status.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.
California applicants: Please Click Here for CA Employee Privacy Policy.
Job Category: Administrative / Clerical / Payroll / HR / Accounting
Job Type: Full Time
Req ID: 5530
Pay Group: CDB
Cost Center: 403
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.
Transdev is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, national origin, age, disability, veteran status, genetic data, gender identity, sexual orientation, religion or other legally protected status, or any other classification protected by federal, state, or local law.
Drug-free workplace
If based in the United States, applicants must be eligible to work in U.S. without restrictions for any employer at any time; be able to pass a drug screen and background check.
California applicants: Please Click Here for CA Employee Privacy Policy.
About Transdev
Cities, counties, airports, companies, and universities across the U.S. contract with Transdev to operate their transportation systems, maintain their vehicle and fleets, and deliver on mobility solutions. Transdev U.S. employs a team of 32,000 across 400 locations while maintaining more than 17,000 vehicles.
Part of a global company, Transdev is a leader in mobility with operations in 19 countries, proudly operated by 110,000 team members from around the world. As an operator and global integrator of mobility, we are driven by our purpose. Transdev - the mobility company - empowers the freedom to move every day thank to safe, reliable, and innovative solutions that serve the common good. Find out more at or watch an overview video.
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1
Network Specialist
32232 Jacksonville, Florida
Tyto Athene
Posted 4 days ago
Job Viewed
Job Description
**Description**
Tyto Athene is searching for a **Network Specialist** to support our NE&S contract remotely. The Network Specialist ensures that the Department of Defense (DoD) Defense Health Agency (DHA) LAN/WAN provides all required services, by supporting the network infrastructure with on-site troubleshooting and problem resolution.
**Responsibilities:**
+ Provides daily operational support for the LAN core and edge switches across the medical network campus
+ Resolves technical issues associated with network and routing protocols at all levels of the OSI model utilizing diagnostic and network administration tools
+ Provides overall network infrastructure support to routing and switching equipment, firewalls, and associated cabling
+ Plans, installs, and supports hardware and software upgrades, and resolves associated technical issues
**Qualifications**
**Required:**
+ Clear understanding of OSI Model Layers 1-3, to include TCP/IP, VTP, SMTP, SNMP, DNS, DHCP, routing protocols, and EIA/TIA cable standards
+ Must be familiar with firewall and VPN technologies
+ Strong network experience maintaining switches and routers, and troubleshooting LAN/WAN problems
+ Good knowledge of general security methodologies
+ Must have strong oral and written communications skills
+ Bachelor's degree in a technical discipline such as Computer Science, Engineering or related technical discipline and 3 years related experience, or;
+ Completion of certification program at a technical or vocational school and 8 years related experience
+ Compliance with DoD Directive "Information Assurance Training, Certification, and Workforce Management required
+ Security+ CE certification required
+ Current CCNA, or Juniper/Brocade equivalent, desired
+ DoD and/or medical network experience preferred
**Location:**
+ Remote
**About Tyto Athene**
**Compensation:**
+ Compensation is unique to each candidate and relative to the skills and experience they bring to the position. The salary range for this position is typically between $75,000-$85,000. This does not guarantee a specific salary as compensation is based upon multiple factors such as education, experience, certifications, and other requirements, and may fall outside of the above-stated range.
**Benefits:**
+ Highlights of our benefits include Health/Dental/Vision, 401(k) match, Paid Time Off, STD/LTD/Life Insurance, Referral Bonuses, professional development reimbursement, and parental leave.
Tyto Athene is a trusted leader in IT services and solutions, delivering mission-focused digital transformation that drives measurable success. Our expertise spans four core technology domains-Network Modernization, Hybrid Cloud, Cybersecurity, and Enterprise IT-empowering our clients with cutting-edge solutions tailored to their evolving needs. With over 50 years of experience, Tyto Athene proudly support Defense, Intelligence, Space, National Security, Civilian, Health, and Public Safety clients across the United States and worldwide.
At Tyto Athene, we believe that success starts with our people. We foster a collaborative, innovative, and mission-driven environment where every team member plays a critical role in shaping the future of technology. Are you ready to join #TeamTyto?
Tyto Athene, LLC is an Equal Opportunity Employer; all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, (sexual orientation, gender identity,) national origin, disability, status as a protected veteran, or any characteristic protected by applicable law.
Submit a Referral ( _US-Remote_
**ID** _ _
**Category** _Information Technology_
**Position Type** _Temporary_
**Remote** _No_
Tyto Athene is searching for a **Network Specialist** to support our NE&S contract remotely. The Network Specialist ensures that the Department of Defense (DoD) Defense Health Agency (DHA) LAN/WAN provides all required services, by supporting the network infrastructure with on-site troubleshooting and problem resolution.
**Responsibilities:**
+ Provides daily operational support for the LAN core and edge switches across the medical network campus
+ Resolves technical issues associated with network and routing protocols at all levels of the OSI model utilizing diagnostic and network administration tools
+ Provides overall network infrastructure support to routing and switching equipment, firewalls, and associated cabling
+ Plans, installs, and supports hardware and software upgrades, and resolves associated technical issues
**Qualifications**
**Required:**
+ Clear understanding of OSI Model Layers 1-3, to include TCP/IP, VTP, SMTP, SNMP, DNS, DHCP, routing protocols, and EIA/TIA cable standards
+ Must be familiar with firewall and VPN technologies
+ Strong network experience maintaining switches and routers, and troubleshooting LAN/WAN problems
+ Good knowledge of general security methodologies
+ Must have strong oral and written communications skills
+ Bachelor's degree in a technical discipline such as Computer Science, Engineering or related technical discipline and 3 years related experience, or;
+ Completion of certification program at a technical or vocational school and 8 years related experience
+ Compliance with DoD Directive "Information Assurance Training, Certification, and Workforce Management required
+ Security+ CE certification required
+ Current CCNA, or Juniper/Brocade equivalent, desired
+ DoD and/or medical network experience preferred
**Location:**
+ Remote
**About Tyto Athene**
**Compensation:**
+ Compensation is unique to each candidate and relative to the skills and experience they bring to the position. The salary range for this position is typically between $75,000-$85,000. This does not guarantee a specific salary as compensation is based upon multiple factors such as education, experience, certifications, and other requirements, and may fall outside of the above-stated range.
**Benefits:**
+ Highlights of our benefits include Health/Dental/Vision, 401(k) match, Paid Time Off, STD/LTD/Life Insurance, Referral Bonuses, professional development reimbursement, and parental leave.
Tyto Athene is a trusted leader in IT services and solutions, delivering mission-focused digital transformation that drives measurable success. Our expertise spans four core technology domains-Network Modernization, Hybrid Cloud, Cybersecurity, and Enterprise IT-empowering our clients with cutting-edge solutions tailored to their evolving needs. With over 50 years of experience, Tyto Athene proudly support Defense, Intelligence, Space, National Security, Civilian, Health, and Public Safety clients across the United States and worldwide.
At Tyto Athene, we believe that success starts with our people. We foster a collaborative, innovative, and mission-driven environment where every team member plays a critical role in shaping the future of technology. Are you ready to join #TeamTyto?
Tyto Athene, LLC is an Equal Opportunity Employer; all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, (sexual orientation, gender identity,) national origin, disability, status as a protected veteran, or any characteristic protected by applicable law.
Submit a Referral ( _US-Remote_
**ID** _ _
**Category** _Information Technology_
**Position Type** _Temporary_
**Remote** _No_
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2
Network Specialist
10528 Harrison, New York
TEKsystems
Posted 2 days ago
Job Viewed
Job Description
IT Support Technician - Infrastructure & End-User Technology
Location: Westchester/Rockland County Region
Workplace Type: On-site
A regional technology service provider is seeking an experienced IT Support Technician to join its managed services team. This role supports a wide range of client environments by providing hands-on troubleshooting, configuration, and operational support for hardware, software, and network systems. The technician will work closely with end users and technical leadership to maintain uptime, resolve issues, and support infrastructure initiatives.
Key Responsibilities
+ Provide desktop and network support across multiple client sites
+ Troubleshoot Windows-based devices, including PCs, laptops, and tablets
+ Support peripheral technologies such as projectors, smart boards, and mobile devices
+ Perform user account management in Active Directory (add/delete users, group policies)
+ Diagnose and resolve network-related issues including IP conflicts, connectivity, and switch/router configurations
+ Assist with server virtualization and basic SAN support
+ Configure and maintain network-based user profiles and workstation setups
+ Implement patches and perform upgrades to network operating systems
+ Collaborate with team leads and client stakeholders to ensure smooth operations and timely issue resolution
Required Skills & Experience
+ Strong background in desktop support and Windows environments (XP, 7, 10)
+ Familiarity with VMware and virtual server environments
+ Experience with Cisco routers, switches, and wireless networking
+ Proficient in troubleshooting email systems and workstation installs
+ Knowledge of LAN/WAN principles and basic SAN environments
+ Ability to manage switch configurations and perform server hardware setup
+ Strong communication and interpersonal skills for client-facing support
+ Ability to work independently and handle multiple priorities across sites
Preferred Qualifications
+ Experience with network operations systems and patch management
+ Familiarity with directory services tools beyond Active Directory
+ CCNA or other certifications are helpful but not required
Interview Prep - Sample Technical Questions
+ What information does IP Config pull?
+ How would you use PING to diagnose a network issue?
+ Describe your experience with Cisco routers and switches
+ What's your approach to wireless network troubleshooting?
+ How have you used Active Directory in past roles?
Pay and Benefits
The pay range for this position is $25.00 - $30.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
- Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully onsite position in Harrison,NY.
Application Deadline
This position is anticipated to close on Nov 13, 2025.
h4>About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
About TEKsystems and TEKsystems Global Services
We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Location: Westchester/Rockland County Region
Workplace Type: On-site
A regional technology service provider is seeking an experienced IT Support Technician to join its managed services team. This role supports a wide range of client environments by providing hands-on troubleshooting, configuration, and operational support for hardware, software, and network systems. The technician will work closely with end users and technical leadership to maintain uptime, resolve issues, and support infrastructure initiatives.
Key Responsibilities
+ Provide desktop and network support across multiple client sites
+ Troubleshoot Windows-based devices, including PCs, laptops, and tablets
+ Support peripheral technologies such as projectors, smart boards, and mobile devices
+ Perform user account management in Active Directory (add/delete users, group policies)
+ Diagnose and resolve network-related issues including IP conflicts, connectivity, and switch/router configurations
+ Assist with server virtualization and basic SAN support
+ Configure and maintain network-based user profiles and workstation setups
+ Implement patches and perform upgrades to network operating systems
+ Collaborate with team leads and client stakeholders to ensure smooth operations and timely issue resolution
Required Skills & Experience
+ Strong background in desktop support and Windows environments (XP, 7, 10)
+ Familiarity with VMware and virtual server environments
+ Experience with Cisco routers, switches, and wireless networking
+ Proficient in troubleshooting email systems and workstation installs
+ Knowledge of LAN/WAN principles and basic SAN environments
+ Ability to manage switch configurations and perform server hardware setup
+ Strong communication and interpersonal skills for client-facing support
+ Ability to work independently and handle multiple priorities across sites
Preferred Qualifications
+ Experience with network operations systems and patch management
+ Familiarity with directory services tools beyond Active Directory
+ CCNA or other certifications are helpful but not required
Interview Prep - Sample Technical Questions
+ What information does IP Config pull?
+ How would you use PING to diagnose a network issue?
+ Describe your experience with Cisco routers and switches
+ What's your approach to wireless network troubleshooting?
+ How have you used Active Directory in past roles?
Pay and Benefits
The pay range for this position is $25.00 - $30.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
- Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully onsite position in Harrison,NY.
Application Deadline
This position is anticipated to close on Nov 13, 2025.
h4>About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
About TEKsystems and TEKsystems Global Services
We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
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3
Provider Network Specialist
85067 Phoenix, Arizona
Sedgwick
Posted 1 day ago
Job Viewed
Job Description
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Is this job a match or a miss?
View Now
4
Provider Network Specialist
99811 Juneau, Alaska
Sedgwick
Posted 1 day ago
Job Viewed
Job Description
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Is this job a match or a miss?
View Now
5
Provider Network Specialist
02133 Boston, Kentucky
Sedgwick
Posted 1 day ago
Job Viewed
Job Description
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Is this job a match or a miss?
View Now
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6
Provider Network Specialist
21401 Annapolis, Maryland
Sedgwick
Posted 1 day ago
Job Viewed
Job Description
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Is this job a match or a miss?
View Now
7
Provider Network Specialist
04332 Augusta, Maine
Sedgwick
Posted 1 day ago
Job Viewed
Job Description
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Is this job a match or a miss?
View Now
8
Provider Network Specialist
70806 Baton Rouge, Louisiana
Sedgwick
Posted 1 day ago
Job Viewed
Job Description
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Provider Network Specialist
**PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MCO services; and to work with MCO provider on physician credentialing, MCO additions and removals, network and problematic issues.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
+ Works directly with clients, program managers, and MCO covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MCO'S.
+ Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MCO provider additions and removals, MCO network issues; makes recommendations for resolution.
+ Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MCO providers.
+ Communicates with injured workers relative to the provider pre-designation rules and procedures.
+ Maintains MCO matrix as to the status of client's respective MCO.
+ Communicates with clients relative to their MCO status.
+ Ensures claims management system parameters are set for MCO flags.
+ Responds to client and MCO covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred.
**Experience**
Four (4) years of related experience or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
**Skills & Knowledge**
+ Thorough knowledge of MCO regulations, practices and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Ability to work independently
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($1.40 - 26.00/hour_** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
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