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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
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Responsible for the coordination and completion of the audit reviews, reviewing audit work papers and reports completed by department staff, distributing reports to management, coordinating auditor's assignments, mentoring and coaching department staff, and assisting the department manager with the direction of the workflow of various risk management activities and special projects. Description
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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, providers, and activities of the corporation including e
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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 40% Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation including evaluatio
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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
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Plan, design, and develop complex and business critical software solutions, utilizing appropriate software development methodologies either individually or as part of a project team. Responsible for ensuring that browser based systems and applications meet client requirements and operate properly, using software development methodologies. Description 25% Develop functional design and technical s
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THIS POSITION HAS THE ABILITY TO WORK FROM HOME IN ALABAMA. 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 wit
Posted Today
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 40% Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation including evaluati
Posted Today
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
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Responsible for group and individual product sales and marketing/promoting products at events through the use of the BlueCross Mobile Unit. Provides sales and service to customers seeking insurance at community events. Responsible for set up and clean up of the Mobile Unit. Maintains current knowledge of all assigned insurance products. Customarily and regularly engaged in outside sales. Descript
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Assists in the development of employee compensation programs that support organizational objectives, fit organizational culture and facilitate attracting, retaining, rewarding high performance employees. Consults with HR and organizational management to provide compensation recommendations and options that align with the overall structure of the BCBSSC organization. Conducts analysis of job conten
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Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings. Description 30% Develops, maintains, and executes complex database programs for the extraction and presentation of data for standard and a
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Responsible for the sales, service, and administrative activities and relationship management to prospective and existing accounts. Customarily and regularly engaged in outside sales. Description 50% Responsible for renewal and management of existing accounts. Maintains strong service relationships with clients and agents. Researches/compiles presentations and sales materials as needed. Coordina
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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. Position is Work At Home Description CGS Administrators provides a variety of services, under contracts with the Centers for Medi
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BlueCross BlueShield of South Carolina
- Charleston, SC / Columbia, SC / Birmingham, AL / 2 more...
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
Posted Today
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