Network Operations Laision

Who We Are

Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data‑driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

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Ready to orchestrate seamless network partnerships that power client success?

Network operations can make or break client implementations and ongoing satisfaction. As our Network Operations Liaison, you'll serve as the critical connection point between our TPA and Wellbeing Operations teams and major national healthcare networks. You'll ensure file exchanges flow smoothly, claims acquisition processes run without hiccups, and carrier relationships stay productive. Your strategic oversight and hands‑on problem‑solving directly impact whether clients experience seamless network integration or frustrating operational barriers.

• Evaluate network capabilities:
  Assess Personify Health network capabilities and define clear feasibility guidelines to support client commitments, sales opportunities, and solution design.
• Lead network integration design:
  Design the end‑to‑end plan, member, and client experience as it relates to carrier and network integration, including Domestic Tier & Hospital Design structure and configuration logic.
• Serve as RFP network expert:
  Act as primary point of contact for all network‑related RFP inputs, feasibility assessments, and design questions during sales processes.
• Coordinate cross‑functional operations:
  Liaison between Account Management, Implementations, Data Operations, and external carrier/network partners to troubleshoot and resolve operational issues.
• Build tracking and accountability systems:
  Design and maintain tracking systems (consolidated Jira dashboards or automated summaries) to monitor all outstanding requests with networks, carriers, and payors across the enterprise.
• Conduct performance reviews:
  Lead weekly/monthly reconciliations and performance check‑ins with each network/carrier/payor, managing backlogs and monitoring SLA adherence.
• Remove operational barriers:
  Intervene with networks to resolve aged issues, realign expectations when workflows fall behind, and connect disparate contacts within single networks to streamline communication.
• Manage escalations and SLAs:
  Support Account Managers and Implementation Managers in preparing escalations to brokers, clients, or carrier leadership while defining and maintaining SLA frameworks for implementations, renewals, and issue resolution.
• Drive continuous improvement:
  Refine processes, relationships, and workflows to continually improve network partnership efficiency and outcomes.

• Bachelor's degree in business administration, healthcare management, or related field
• 7+ years in network operations, vendor management, or related healthcare services role
• Experience defining, managing, and enforcing SLAs with external partners
• Proven track record managing complex cross‑functional initiatives and external vendor relationships with major carriers

• Deep understanding of healthcare networks and carrier operational workflows (Anthem, Aetna, UHG, Cigna structures, file exchanges, service models, escalation paths)
• Knowledge of TPA operational processes including claims workflows, eligibility exchanges, provider/network configurations, and benefit design implications
• Proficiency with EDI file formats and standards (837, 835, 834, 270/271) and ability to interpret and troubleshoot file exchange discrepancies
• Understanding of network tiering, hospital design, and benefit configuration frameworks
• Working knowledge of Jira or similar ticketing systems for consolidating cross‑team work streams
• Knowledge of legal, contractual, and regulatory requirements related to healthcare network operations

• Competitive base salary and benefits…