The Authorization Assistant provides technical and clerical support for assigned focus areas, including verifying member eligibility, network providers, and benefit codes. They are responsible for processing authorization requests, documenting actions, and communicating effectively with members and providers while adhering to regulatory requirements.
The analyst performs comprehensive data analysis and visualization to support healthcare quality improvement initiatives using tools like Tableau and SQL. They collaborate with stakeholders to provide data-driven insights, manage regulatory deliverables, and serve as a subject matter expert on clinical quality measures.
The Data Analyst II is responsible for conducting moderately complex data analysis, creating reports, and developing dashboards to support decision-making. They also act as a data steward, ensuring data integrity and collaborating across departments to improve operational performance.
Coordinate the translation of member health care and insurance materials by managing vendor resources and ensuring project deadlines are met. Collaborate with multidisciplinary teams to maintain translation quality, branding standards, and compliance requirements.
The Registered Nurse supports utilization management functions including benefit reviews, appeals, and grievances to determine medically appropriate services. They collaborate with Medical Directors and clinical staff to ensure service requests and authorizations align with state and federal guidelines.
This role involves designing and developing data models, ETL specifications, and data warehouse architectures at an intermediate level. The architect will also conduct data analysis, manage vendor relations, and ensure system compliance with established standards.
The IS Security Engineer II is responsible for designing, implementing, and maintaining corporate security systems to support business strategies. This role involves managing security technologies, analyzing business needs, and ensuring compliance with established security policies and standards.
The Actuarial Services Manager is responsible for managing actuarial components of financial reporting, including IBNR estimates, trend forecasting, and cost modeling. They also provide leadership to the actuarial team, ensuring alignment with organizational goals and effective cross-functional collaboration.
