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 investigations, manage overpayment recoveries, and resolve appeals while maintaining production standards.
The VP of Health Services Analytics will lead the development of a data-driven operating system by implementing unified KPI dashboards and AI-powered insights to improve member outcomes and operational efficiency. This role is responsible for migrating legacy analytical functions to modern cloud platforms while aligning strategic priorities across the organization.
The RN Case Manager is responsible for creating, implementing, and monitoring treatment plans to assist members in meeting their healthcare goals. They will coordinate care, assess clinical status, and identify cost-effective resources while ensuring quality care standards.
The Claims Examiner is responsible for the day-to-day processing, adjudication, and research of medical, dental, vision, and mental health claims. They also facilitate investigations, negotiate settlements, and manage overpayment recovery while ensuring compliance with policy guidelines.
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.
