Job Information
Genex Services, LLC. Network Relations Specialist in Wayne, Pennsylvania
Coventry Network Relations Specialist USRemote Job ID: 24-17311 Type: Regular Full-Time # of Openings: 1 Category: Customer Service & Support Mitchell International, Inc. Overview The Enlyte Family of Businesses Mitchell | Genex | Coventry
Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.
Responsibilities
Reviews and analyzes contracts to resolve provider disputes. Verifies system logic of various applications to ensure compliance with contract and compensation policies and procedures, parameters, and process. Examines contract performance in support of network quality, availability, and financial goals and strategies of Aetna and Coventry. Manages priority projects to ensure that a provider dispute is resolved, which may involve negotiation of settlement agreement Collaborates cross-functionally to review and resolve provider and legal issues and/or disputes. Educates and optimizes interaction with markets, providers and internal business partners to manage relationships and ensure provider needs are met. Triages and resolves escalated issues as assigned by leadership and senior leadership.
Qualifications Minimum Education * High School Diploma or equivalent Required Skills and Experience * 2-4 years of industry related experience Desired Skills and Experience * Knowledge of Workers Compensation and auto medical insurance * Pricing Hub, Provider Hub, SalesForce, and/or PCM experience preferred * Strong wral and written communication
Salary: PI251631359