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Health Network Operations Specialist

Apply now Job no: 495737
Recruiter: Allison Plummer
Hiring Manager: Ashley Trice
Salary Grade: I-8
Work type: Regular
Location: Omaha, Nebraska, Lincoln, Nebraska, Columbus, NE, Kearney, Nebraska, Norfolk, NE, North Platte, NE, Scottsbluff, Nebraska, Nebraska, United States, Austin, TX, Des Moines, Iowa, Denver, CO, Kansas City, Missouri
Categories: Administration, Clinical Provider Support, Analytics

Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Colorado, Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

What you'll do:

  • Represent Provider Services in organization changes that have potential impact to the department.
  • Researches, coordinates, manages, and implements Provider Services projects
  • Operates as a Subject Matter Expert (SME) with extensive business and technical knowledge on the feasibility and implementation of system and process changes.
  • Engages the appropriate individuals, teams and/or groups regarding technology/platform changes that affect the business.
  • Provides final approval for requirements, functional specs and user acceptance test scenarios.
  • Participates on internal and external cross-function work groups and provides guidance and shared knowledge on technical and interpersonal escalated issues.
  • Provides accurate provider data analytics to the assigned administration team and collaborative partnerships as appropriate.
  • Works on association releases, complex special projects, federal mandates, and network implementations
  • Understand downstream impact of provider data and monitor the flow of data to external vendors by coordinating with I/S teams and vendor relations contacts.
  • Coordinates and completes other tasks and projects as assigned by management
  • Responsible for keeping provider data for multiple systems in sync for the enterprise. Includes data reconciliation efforts and system adjustment activities.
  • Update system data that is identified as needing changes in analysis. Collaborate with training team on new process needs.

To be considered for this position, you must have:

  • Bachelor’s degree in business, information technology or related field and five (5) years of experience in a data analysis or technical business-related role in the health care industry.
  • Intermediate knowledge in SQL
  • 3+ years’ experience in implementing data controls
  • Demonstrated experience in performing issue research and resolution
  • Strong knowledge of business development, strategic planning, support and process improvement

The strongest candidates for this position will also possess:

  • Experience in AGILE methodology
  • Claims and/or provider relations experience

Learn more about what makes BCBSNE such an exceptional place to work by visiting

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans



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