The Case Management Coordinator is responsible for accurate claim intake, maintenance, and validating policy coverage throughout the claim lifecycle. They also coordinate communications between internal teams, plan members, and external stakeholders to ensure timely claim processing.
The Case Manager is responsible for adjudicating Short-Term and Long-Term Disability claims, including initial decision-making and ongoing management. They will develop treatment plans, facilitate return-to-work programs, and provide expert advice to internal and external stakeholders.
The pharmacist will apply clinical knowledge to determine drug eligibility via special authorization and support the Drug Review Committee. They will also provide recommendations on drug products and management processes in a non-traditional clinical setting.
The Member Experience Representative proactively engages clients to ensure they maximize the value of their health, dental, and life insurance benefits. This role involves onboarding new clients, providing personalized guidance, and building long-term relationships to foster loyalty and retention.
Assess Special Authorization requests by applying clinical expertise and evidence-based guidelines to determine medication coverage eligibility. Document decision rationales in company systems and provide professional correspondence to prescribers and subscribers regarding coverage outcomes.
The role involves driving market share through consistent sales performance and managing a high volume of inbound and outbound customer calls. You will also collaborate with internal stakeholders to ensure exceptional customer service and administrative accuracy in contract processing.
The Contract Administrator is responsible for the accurate and timely generation of new group contracts and existing contract amendments. They also handle complex enrollment issues and collaborate with internal departments to ensure benefit accuracy.
The Payment Specialist is responsible for calculating and processing life and disability payments while ensuring compliance with contract terms and internal approvals. They also manage overpayments, financial reporting, and year-end tax documentation.
The representative responds to telephone inquiries from health care providers regarding benefit eligibility, claim submissions, and plan requirements. They also document call details, analyze workflows, and provide feedback to management to improve processes.
