The Account Manager serves as the primary liaison for self-funded group health plans, managing client relationships and ensuring overall satisfaction. Responsibilities include conducting performance reviews, implementing plan changes, and facilitating renewals while providing legislative and compliance updates.
The RRT Analyst is responsible for handling claim adjustments, repricing, and group exception referrals in a timely manner. They also perform accumulator updates and manage assigned projects to ensure claim accuracy.
The Plan Building Analyst is responsible for coding and maintaining group benefit plans within the Qiclink system to ensure accurate claims processing. They also audit completed tasks, manage prescription accumulators, and provide documentation for system upgrades.
The supervisor will lead a team in delivering high-quality data analysis, reporting, and infrastructure support while modernizing the reporting stack. They are responsible for quality assurance, stakeholder collaboration, and the professional development of their team members.
The Repricing Specialist I is responsible for re-pricing medical and dental claims using multiple applications to ensure accurate discounted rates. They also handle escalated issues, manage workflow updates, and assist with client-specific product implementations.
The EDI Specialist is responsible for the daily retrieval, submission, and auditing of inbound and outbound data files. They also provide support to trading partners, conduct eligibility matching, and train staff on updated departmental procedures.
The Scrum Master II coordinates cross-functional Agile teams by facilitating Scrum events, removing blockers, and supporting self-organized teams. They are responsible for tracking project progress, managing risks, and ensuring the effective use of Agile principles to deliver solutions.
The Manager of Claims Processing leads teams to ensure claims are handled accurately according to SLAs, regulatory standards, and plan documents. They are responsible for managing claim inventories, coaching staff, and implementing strategies to improve process efficiency and member experience.
The Senior Data Analyst will lead end-to-end inbound and outbound EDI implementation projects, specifically focusing on ANSI X12-834 eligibility files. They will also serve as the primary point of contact for troubleshooting data discrepancies and maintaining data integrity across trading partner platforms.
The specialist is responsible for preparing, filing, and monitoring medical stop loss claims for reimbursement while managing the appeals process for denied claims. They must also maintain accurate documentation and communicate effectively with internal departments and external carriers to resolve claim issues.
The Case Management Liaison assists with managing internal and external relationships, department escalations, and vendor processes. They also act as a department spokesperson, document complex systems, and provide training to staff and clients.
The Treasury Services Specialist acts as a subject matter expert for daily treasury processes, including monthly reconciliations and business banking setup. The role also involves building new processes, providing team training, and supporting vendor maintenance and payment implementation.
The GRC Analyst supports the development and maintenance of security controls while ensuring regulatory compliance across the organization. They are responsible for conducting risk assessments, managing vendor due diligence, and facilitating internal and external audits.
The Billing Coordinator manages the end-to-end group medical premium billing cycle, including account setup, invoice generation, and validation of billing outputs. They collaborate with internal teams to resolve billing discrepancies and ensure alignment with quoted rates and system configurations.
The Senior Refund Analyst is responsible for logging, tracking, and processing all refunds received on claims. They also coordinate with department personnel to determine refund appropriateness and generate monthly reports on processing errors.
The Project Manager, Operations is responsible for managing the implementation of operational projects, new products, and services through the PMO delivery framework. They will collaborate with cross-functional teams to plan, execute, and deliver projects while ensuring alignment with governance and reporting standards.
The Supervisor, Stop Loss assists in overseeing department operations, including auditing claim filings, tracking reimbursements, and managing cash advance claims. They are also responsible for leading, coaching, and developing staff through performance appraisals and training initiatives.
The Software Engineer I is responsible for maintaining and developing software applications while contributing to the application development process through coding, debugging, and testing. They will work in an agile environment to design, release software enhancements, and collaborate with QA to build automation tests.
The Project Leader is responsible for managing the implementation of new projects within the Claims Distribution and Repricing Department. They will analyze current workflows and systems to provide recommendations for process improvements and act as the primary point of contact for stakeholders.
The Appeals Specialist organizes and completes all claim appeals by reviewing supporting documentation and Summary Plan Documents. They are responsible for composing response letters, documenting outcomes in the QicLink system, and communicating with clients and other departments.
The Billing Specialist I will assist in file imports, state reporting, client invoicing, and maintaining reports. They will also follow up on payments, resolve discrepancies, and collaborate with other departments for accurate billing.
Manage a book of self-funded group health plans, serving as the primary liaison between clients, brokers, and internal departments. Responsibilities include overseeing new business implementation, conducting plan performance reviews, and ensuring overall client satisfaction.
The Data Analyst manages inbound and outbound EDI projects, specifically focusing on ANSI X12-834 eligibility files and custom data extracts. They are responsible for configuring, testing, and monitoring data integrations while resolving discrepancies between internal teams and external partners.
The Client Service Representative acts as the primary point of contact for members, brokers, and HR representatives to resolve inquiries and issues. They liaise between clients and internal departments to manage claim resolutions, reporting, and the renewal of existing cases.
