Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description 65% May perform any or all of the following in the enrollment of providers determines the acceptability of provider enrollment applications (which may

Under general supervision, performs a variety of routine to moderately complex clerical/accounting functions such as inventory balancing, reconciliations, generating refund request letters, processing disbursements and deposits, keying journal entries and logging items in accordance with standard procedures in one or more of the following areas; general accounting, accounts payable, accounts recei

Under general supervision, performs a variety of routine to moderately complex clerical/accounting functions such as inventory balancing, reconciliations, generating refund request letters, processing disbursements and deposits, keying journal entries and logging items in accordance with standard procedures in one or more of the following areas; general accounting, accounts payable, accounts recei

Manages the research and development of new products. Works with various functional areas (marketing, underwriting, actuarial, claims, information systems, finance) to provide innovative approach to new product lines. Description 30% Identifies, researches and analyzes products for profit and growth potential. Utilizes market research in determining need, competition and financial outcome. 30% W

Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description 65% May perform any or all of the following in the enrollment of providers determines the acceptability of provider enrollment applications (which may

Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizati

Responsible for maintaining database files to ensure timely/accurate claims processing. Updates various files/tables related to system access security, status codes and messages, and certain system editing. Develops solutions to business problems/requirements impacting the area's claims. Establishes system access/security for line of business. Troubleshoots/reviews production and test data with cu

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

Responsible for evaluating loss potential for each member. Calculates and assigns risk score via a comprehensive risk analysis approach. Ensures action requests and internal/external issues are addressed in a timely manner. Description Job Duties Utilize statistical tools to extract and analyze data to identify and evaluate loss potential. Required Education Master's degree in Management, Fi

Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review Nurses, Case Management, and/or Medical Review staff and specialty programs. Ensures appropriate levels of healthcare services are provided. Description 60% Manages day to day activities for assigned staff. Identifies training needs and verifies accuracy and timeliness of workflow functions. 20% S

Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plan

Leads corporate distribution systems, general agents, brokers, and other market support personnel. Responsible for planning, product development, marketing services, production and profitability for as few as two states to regions with as many as ten states. Customarily and regularly engaged in outside sales. Description 25% Leads, markets, recruits, and motivates general agents, brokers, and ot

Leads corporate distribution systems, general agents, brokers, and other market support personnel. Responsible for planning, product development, marketing services, production and profitability for as few as two states to regions with as many as ten states. Customarily and regularly engaged in outside sales. Description 25% Leads, markets, recruits, and motivates general agents, brokers, and ot

Leads corporate distribution systems, general agents, brokers, and other market support personnel. Responsible for planning, product development, marketing services, production and profitability for as few as two states to regions with as many as ten states. Customarily and regularly engaged in outside sales. Description 25% Leads, markets, recruits, and motivates general agents, brokers, and ot

Part time internship Intern position utilized for training an active college student towards a professional level role. Responsibilities vary and are based upon the needs of the area and the experience of the incumbent at the time of employment. This incumbent works under direct supervision and has responsibilities for performing entry level tasks and for learning professional level tasks relating