Network Outreach Specialist

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Collect attestation and validation to ensure the accuracy of provider network information as presented in local directories.

• Make outbound calls to providers to confirm demographic details of practitioners for each practice location within Horizon networks.

• Reach out to members concerning preventive health initiatives.

• Respond to inbound service calls, delivering accurate and complete information in response to provider inquiries, complaints, and issues.

• Engage with provider offices to promote ongoing education and communication regarding data management best practices and participate in scheduled orientation and educational outreach events.

• Conduct provider surveys and assessments as needed.

• Serve as a liaison between providers, members, and external community resources.

• Manage PCP/PCD changes for members.

• Confirm PCP/PCD and member eligibility with providers.

• Keep call documentation updated in databases for special outreach initiatives.

• Assist provider offices with credentialing, recredentialing, claims, and provider data maintenance by offering process guidance.

• Ensure adherence to DOBI, CMS, and NCQA accuracy regulations.

⛳️ Requirements

• High School Diploma or GED is required.

• A minimum of 3 years of experience in customer service or telephone sales, preferably within a Managed Care environment.

• Some familiarity with provider practices, physicians, and/or office managers in a healthcare or group practice setting is preferred.

• Knowledge of Horizon products and services is preferred.

• Understanding of the health insurance industry is required.

• Must be skilled in using personal computers and related software in a Windows environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes.

• Should have expertise in utilizing intranet and internet applications.

• Excellent oral and written communication skills are required.

• Strong interpersonal and organizational skills are necessary.

• Ability to effectively resolve problems is a must.

• Candidates must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement