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 Claims Examiner is responsible for the daily processing and adjudication of medical, dental, vision, and mental health claims. They also conduct claims investigations, manage overpayment recoveries, and resolve appeals while maintaining production standards.
The Senior Director leads the business architecture and process excellence disciplines to translate enterprise strategy into a sequenced program of change. This role integrates capability models and process redesigns with AI product roadmaps while ensuring alignment with the enterprise transformation scorecard.
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.
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.
