The Eligibility Service Representative will manage caregiver inquiries and resolve issues related to eligibility, benefits, and premium billing. They will also perform call center functions and collaborate with internal teams to ensure timely and accurate resolution of customer requests.
The Eligibility Service Representative will manage caregiver inquiries and resolve eligibility, hours, or premium issues through various communication channels. They are responsible for conducting research, maintaining client requirements, and collaborating with internal teams to ensure high-quality service delivery.
The Eligibility Service Representative will manage caregiver inquiries and resolve issues related to eligibility, benefits, and premium billing. They will also conduct outreach to internal partners and maintain accurate records while ensuring high-quality customer service across multiple communication channels.
The Eligibility Service Representative is responsible for resolving caregiver inquiries regarding eligibility, benefits, and enrollment issues. They will manage requests through multiple channels while ensuring high-quality service and timely resolution of complex problems.
The Senior Manager is responsible for developing, updating, and managing medical and clinical claim policies to optimize utilization and cost. They collaborate with cross-functional teams to implement these policies, manage system configurations, and ensure compliance with regulatory requirements.
Perform clinical utilization reviews and medical necessity determinations using evidence-based guidelines and national standards. Collaborate with healthcare partners and prepare cases for Medical Director oversight to ensure timely care delivery.
The role involves developing KPIs, statistical models, and predictive analytics to monitor clinical program performance and member outcomes. The analyst will create client-facing dashboards and provide actionable insights to inform healthcare strategy and ROI.
