Provider Engagement Specialist — Remote (OK-Based)

Humana; Oklahoma; Hybrid; USD 59,000 - 81,000; Full time

Benefits offered by this job

Bonus Incentive Plan

Job summary

Humana Healthy Horizons in Oklahoma seeks a Provider Engagement Professional to build and grow positive, long-term relationships with physicians, providers and healthcare systems within the Medicaid plan. The role covers onboarding, training, inquiries, issue resolution, and regional provider events, with a strong focus on service quality and compliance.

Based in Oklahoma, this hybrid role requires travel up to 50% and interaction with claims, enrollment, and other Humana teams to deliver a

Qualifications

• 2+ years of health care or managed care experience working with providers.
• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
• Must reside in Oklahoma.
• Willing and able to travel frequently (up to 50% of time).
• Bachelor’s Degree preferred; Oklahoma Medicaid experience and behavioral health exposure are a plus.

Responsibilities

• Serve as primary relationship manager with physical and behavioral health providers to ensure a positive provider experience and promote network retention.
• Meet regularly with assigned providers to conduct trainings and education on Humana policies and procedures.
• Assist new assigned providers with onboarding and orientation sessions.
• Respond to provider questions and resolve issues with enterprise teams (claims, approvals, referrals) and provide education on participation in the Oklahoma Medicaid plan.
• Convene Service Operating Committee meetings with providers to discuss operational, clinical, and quality topics.
• Communicate updates on Humana policies and Oklahoma programmatic changes.
• Coordinate regional provider townhalls and trainings.
• Work with internal resources (claims, reimbursement, enrollment) to ensure the Perfect Experience in all provider interactions.
• Ensure compliance with Oklahoma’s managed care contractual requirements for provider relations, including timely disputes resolution.

Skills

Health care experience

Provider relations

Claims education/adjudication

Dispute resolution

Education

Bachelor’s Degree

Job description

Humana Healthy Horizons in Oklahoma seeks a Provider Engagement Professional to build and grow positive, long-term relationships with physicians, providers and healthcare systems within the Medicaid plan. The role covers onboarding, training, inquiries, issue resolution, and regional provider events, with a strong focus on service quality and compliance.

Based in Oklahoma, this hybrid role requires travel up to 50% and interaction with claims, enrollment, and other Humana teams to deliver a