The Client Services Specialist acts as the primary point of contact for clients and brokers to resolve medical claim inquiries and benefit plan issues. They coordinate with internal departments to ensure accurate communication, documentation, and timely resolution of service requests.
The Case Manager will evaluate clinical and claims information to develop and implement strategic care plans for members with various health scenarios. They act as a liaison between clients, vendors, and internal departments to optimize processes and ensure positive health outcomes.
Prepare, document, and submit aggregate stop loss claims, monitor their status, and follow up with carriers to secure timely and complete reimbursements. Reconcile and audit aggregate funding positions, respond to carrier information requests, and appeal denied or reduced reimbursements.
The Supervisor of Claims Processing leads daily operations, monitors team productivity and quality, and ensures claims are handled in compliance with regulatory requirements. They provide coaching and guidance to staff, resolve escalated issues, and support process improvements to enhance client and member experiences.
The IT Data Analyst will analyze and improve business processes while collaborating with department leaders to implement enhancements. They are also responsible for developing and maintaining KPI reports and supporting special time-sensitive projects.
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 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 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 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 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 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.
