The Claims Examiner is responsible for the day-to-day processing and adjudication of medical, dental, vision, and mental health claims. They also conduct claims research, investigate overpayments, and facilitate settlements while ensuring compliance with policy guidelines.
The IT Business Systems Analyst acts as a liaison between business areas and IT to define objectives, identify risks, and implement technology solutions. They are responsible for gathering requirements, conducting user acceptance testing, and maintaining technical documentation to support project success.
The Care Coordinator supports non-clinical healthcare operations by serving as a resource for patients, families, and providers while managing telephonic follow-ups. They assist RN Case Managers with administrative tasks, data entry, and the coordination of patient healthcare goals.
The RN Case Manager creates, implements, and monitors treatment plans to help members meet their healthcare goals. Responsibilities include assessing health status, coordinating care with providers, and ensuring cost-effective service delivery.
Serve as a financial strategist and benchmarking authority to drive margin improvement and operational efficiency across a portfolio of care delivery assets. The role involves translating clinical operational decisions into financial impacts and providing strategic guidance to asset-level leadership.
Lead the strategy and execution of GuideWell's acquisition marketing programs while serving as the primary strategic representative for the CMX department to the Government ACA segment. Orchestrate integrated solutions across communications, brand, and customer experience to drive enrollment and business growth.
Provide specialized legal counsel and comprehensive governance support to the Board of Directors and its committees. Manage board materials, update governance policies, and advise on regulatory requirements and risk management.
Drive enterprise-wide technology security strategy with a focus on implementing innovative AI and cloud security solutions. Lead the secure design of cloud foundational controls and manage the migration from on-premise datacenters to public cloud environments.
