16 to 30 of 50
Establishes and maintains provider networks for assigned lines of business. Serves as main contact for all recruiting or recontracting efforts and all contract questions or issues that arise with providers. Recommends and implements cost effective strategies while delivering high quality products to customers. Description 40% Conducts initial/renewal contract negotiations with providers. Perform
Posted 4 days ago
Responsible for analysis, design, programming, and implementation of complex applications tasks and projects. Devise feasible, logical procedures to resolve business problems through the use of computer resources. Formulate scope and objectives through research to develop or modify complex systems. Review detailed specifications and recommend modifications. Design, code, test and debug complex app
Posted 7 days ago
Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members. Description Work hours 8 00 am to 4 30 pm. Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters clai
Posted 7 days ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquires may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description 60% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk in inquiries. Handles si
Posted 7 days ago
THIS POSITION MAY BE WORKED FROM HOME IN ANY STATE. Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description 50% Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, provi
Posted 7 days ago
Sells insurance products through telemarketing. Description 70% Places and answers (inbound and outbound) telephone calls from/to potential customers. Assists with decisions regarding plans and products. 15% Follows up/through on leads provided. 15% Generates letters to prospective customers. Processes applications and prepares marketing/information packets. Required Education High School Diplom
Posted 7 days ago
Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, case management interventions are intended to enhance client safety, well being, and quality of life. These interventions carefully cons
Posted 9 days ago
Negotiates Pharmacy Benefit Management (PBM) contract terms with Commercial Business self funded groups for retail/mail order/specialty pharmacy service and specialty drug medical management rebate sharing services. Monitors contract performance including performance guarantees, financial guarantees, and compliance with state and federal regulatory requirements specific to self funded groups. Nego
Posted 9 days ago
Oversees the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identifies and implements process improvement opportunities. Description 70% Manages the medical review process. Maintains a well trained staff. Develops/implements medical review strategy wit
Posted 10 days ago
Directs development and maintenance of provider network. Provides guidance and direction over staff responsible for any or all of the following areas within the network provider relations, provider contracting, recruitment, fee negotiations, customer services, credentialing, and database management Description 60% Develops and maintains provider network. Directs and oversees activities and staff
Posted 11 days ago
Develops and maintains internet content to effectively communicate with various audiences. Ensures online communications are in compliance with corporate standards of quality and association brand regulations. Description 70% Manages internet content through editing, proofreading, project troubleshooting, testing, research, and client liaison services. 20% Ensures all association branding regula
Posted 11 days ago
Responsible for identifying training needs, developing training materials and facilitating training. Provides training, guidance and leadership for new training specialists. Develops performance assessments and testing materials. Manages trainees and communicates effectively with area management on trainee performance. Description 50% Leads, plans and prioritizes training projects from conductin
Posted 11 days ago
Responsible for moderately complex accounting activities relating to the maintenance of a complete and accurate general ledger and/or the resultant managerial reports and/or financial statements. Description 30% Reconciles assigned general ledger accounts of routine to moderate complexity. Initiates and/or processes journal entries into various accounts. Performs reviews of various systems activ
Posted 11 days ago
Consults with lines of business leadership, retail and marketing staff, etc. to offer guidance on editorial content and ad direction. Works closely with media relations staff to amplify corporate news and augment traditional media channels. Manages customer service issues that surface via social media and works with HR on recruitment messaging, and with customer experience to ensure that efforts a
Posted 14 days ago
We are seeking a motivated Federal Business Development and Capture Manager to provide the full cycles sales process regarding new business development in the federal health care marketspace. Manages all activities of proposal development. Responsible for searching out, understanding, verbally articulating detailed analysis of RFPS, RFIS, RFQS, and other documents. Collaborates with management, Su
Posted 14 days ago
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