This position involves working in a call center to assist members and physicians by responding to telephone and written inquiries. The role requires conducting research and spending approximately 85-90% of scheduled time on the phone.
This role involves providing telephonic and field-based care coordination to members to address their personal health needs and goals. The manager will conduct comprehensive health assessments and care planning while supporting clinical operations through provider and member engagement.
This role involves implementing, maintaining, and analyzing actuarial models for pricing, underwriting, and forecasting. The analyst will also develop presentations to communicate findings and support business decision-making.
This role involves recruiting and contracting with various healthcare providers, including physicians and facilities, to ensure strategic network coverage. The consultant will also manage provider relationships, negotiate contracts, and provide ongoing education and support to the network.
This position is responsible for contracting and network governance activities, including executing business plans and strategies for the division. The role involves collaborating with leadership to align divisional strategies with enterprise goals and managing both short-term and long-term planning.
The Customer Service Representative will resolve customer issues quickly and accurately while navigating multiple systems and screens. They are responsible for providing service excellence in a fast-paced, structured environment while maintaining high quality metrics.
This role involves planning and conducting training sessions, performing detailed audits, and analyzing programs to ensure compliance with standards. Additionally, the analyst will manage projects and create desk-level procedural documents for provider data entry.
The Claim Correction Analyst is responsible for managing claim corrections, including voids, history adjustments, stop payments, and refunds. They also coordinate with the legal department and fund accounting to resolve payment and check-related issues.
This position supports the development of divisional strategies and identifies tools to track strategic opportunities. It involves providing end-to-end report development and facilitating communication between business and technical teams to achieve organizational goals.
The Claims Corrections Analyst is responsible for processing system claims corrections, including voids, history adjustments, stop payments, and refunds. This role requires maintaining high accuracy and efficiency within a fast-paced, customer-service-driven environment.
The Medical Director is responsible for managing medical policies and programs while performing clinical reviews. They also interact with provider communities to ensure quality care standards.
The Customer Advocate Specialist is responsible for analyzing, resolving, and coordinating the processing of telephone and written inquiries. They also provide unit-specific coaching to customer service advocates and handle escalated customer issues.
This role supports the development and delivery of operational performance reporting to enable informed decision-making. The specialist independently analyzes data, develops reporting solutions, and translates business requirements into actionable insights while adhering to data governance standards.
This position provides assistance to providers and Indian Health Services by analyzing and resolving inquiries related to claims, pricing, and benefits. The role also acts as a liaison between providers and IHS while contributing to project testing and process improvements.
This position involves working in a call center to assist members and physicians by responding to inquiries in a prompt and accurate manner. The role requires conducting research and spending approximately 85-90% of scheduled time on the phone.
This role supports the provider recruitment and contracting process to ensure network adequacy through analysis and gap reporting. It also involves managing complex hospital and physician contracting activities and monitoring project milestones.
This role is responsible for supporting national value-based arrangements through contract analysis, trend review, and the development of ad hoc reporting. The consultant will lead financial reporting activities and collaborate across departments to ensure project goals are met.
The consultant ensures field contractors comply with contracting standards, regulatory requirements, and internal governance policies. They provide ongoing guidance to field contractors and collaborate with Legal and Compliance teams to manage non-standard issues.
This role supports the evaluation of Medicare regulatory requirements and CMS guidance to assess compliance risks for government contracts. The consultant will act as a subject matter expert to ensure regulatory requirements are implemented across internal operations and delegated entities.
This position is responsible for processing complex claims that require further investigation and coordination of benefits. The role also involves resolving pended claims under supervision.
This role is responsible for creating reports, insights, and analytics to support divisional strategic initiatives and business needs. The analyst will interface between business and data teams to interpret trends, build actionable tools, and present findings to stakeholders.
The Senior Data Product Manager is responsible for the full lifecycle management of products from strategic planning to tactical execution. They lead cross-functional teams to deliver business outcomes while managing product roadmaps, financial allocations, and stakeholder consensus.
The Senior Sales Manager is responsible for leading Individual Medicare sales across Tennessee and Arkansas by managing a team of Broker Sales Representatives. This role focuses on executing market growth strategies, strengthening broker partnerships, and ensuring alignment with enterprise sales priorities.
The specialist will oversee and monitor Prescription Drug Plan (PDP) enrollment and premium billing operations to ensure compliance with CMS requirements. They will also collaborate with vendors and internal partners to identify process improvements and support audit activities.
The associate is responsible for selling healthcare-related products through inbound and outbound calls and digital channels. They must conduct consultative needs assessments, manage leads, and ensure all sales activities comply with CMS and company standards.
This role is responsible for aligning project designs with the application architecture roadmap and supporting functional and technical design activities. The architect will define interactions between application packages, databases, and middleware systems while acting as a subject matter expert for integration.
The role involves managing the implementation, maintenance, and analysis of actuarial models for pricing, underwriting, and reserving functions. It also requires developing complex models, training staff, and leading projects that involve both internal and external stakeholders.
The COBRA Analyst oversees all aspects of the COBRA client and member experience, including benefit elections, payments, and reporting. This role manages inbound and outbound communications via phone, email, and fax for COBRA, FMLA, and leave programs.
This role is responsible for developing and managing network strategies, drafting reimbursement contracts, and negotiating agreements for commercial and government networks. The position also oversees staff operations, manages budgets, and ensures network adequacy while resolving contractual disputes.
The Claim Technician is responsible for processing, adjudicating, and resolving complex healthcare claims in accordance with company policies and regulatory requirements. This role involves investigating claim discrepancies, coordinating benefits, and collaborating with providers and internal departments to ensure accurate and timely resolution.
This position is responsible for designing enhancements and new business applications by integrating technical and business requirements. The role serves as a technical designer to identify optimal solutions and technical specifications while linking business needs to architectural definitions.
This role leads a team in developing and executing Medicare Advantage product and bid strategies while driving cross-functional collaboration. The manager evaluates product performance, conducts market analysis, and ensures alignment with regulatory requirements and long-term growth goals.
The Infrastructure Engineer will improve the Virtual Desktop experience through automation, design, and the creation of repeatable deployment patterns. They will collaborate with engineering and operations teams to manage desktop virtualization roadmaps and transition knowledge to support staff.
This position is responsible for managing medical policies and programs while performing medical reviews. The role involves interacting with provider communities to ensure effective healthcare delivery.
This role is responsible for developing business plans and provider network strategies across multiple lines of business including Commercial, ACA, Medicare, and Medicaid. The leader will design, optimize, and plan long-term provider networks while partnering with cross-functional teams to ensure measurable business outcomes.
This position oversees provider relations, network strategy development, and reimbursement contract negotiations for Medicare Advantage and Medicaid programs. The role is responsible for managing contracting operations, ensuring network coverage, and overseeing staff performance and budgets.
This position is responsible for managing medical policies and programs while performing medical reviews. The role involves interacting with provider communities to ensure effective clinical oversight.
The Senior Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, and vision claims while serving as a liaison for internal departments. They also analyze claim information to make benefit determinations in accordance with policy provisions and state or federal laws.
This position is responsible for leading and controlling financial reporting and analysis while developing the company's financial reporting strategy. The role also involves advising and consulting senior management on financial accounting and reporting matters.
This role leads the development and execution of Medicare Advantage bid strategies, service area roadmaps, and overall bid process governance. The manager oversees a multifaceted function including analytics, project management, and operational readiness to ensure critical business outcomes.
The role is responsible for executing sales strategies to drive membership growth by managing relationships with brokers, agencies, and providers. Key tasks include recruiting partners, conducting sales presentations, training agents, and monitoring performance metrics using CRM tools.
This position is responsible for conducting care management and health education programs for customers enrolled in government health care programs. The role also involves gathering, analyzing, and providing data for regulatory reports while representing the company to members.
The Executive Director is responsible for retaining and growing hospital and health system accounts by developing strategic business plans and product roadmaps. They will lead a team of client managers and serve as an executive sponsor to ensure client satisfaction, profitability, and effective resolution of complex issues.
The Manager of FP&A will lead financial planning, forecasting, and reporting to support the company's strategic business objectives. This role involves managing value-based care contract modeling and collaborating with executive leadership to drive financial performance and process improvements.
The Senior Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, and disability claims in accordance with plan documents and legal regulations. They also serve as a liaison for internal departments and provide guidance to team members regarding claim processing procedures.
The Head of Group Retiree Sales is responsible for driving revenue growth and market share in the Medicare retirement space through strategic go-to-market planning. This role involves leading a team of sales professionals and collaborating with product and compliance teams to deliver solutions to large employers.
Respond to high-volume telephonic and electronic inquiries regarding benefits, eligibility, and claim status. Accurately document all actions and navigate multiple system applications to resolve customer issues.
Supervise and manage a remote team of inbound and outbound customer service representatives to ensure exceptional service delivery. Responsible for meeting client service expectations, achieving service objectives, and fostering staff development.
Supervise and manage a remote team of inbound and outbound customer service representatives to deliver exceptional service. Ensure the achievement of client service expectations, health benefits objectives, and staff development.
Manage and coordinate a high volume of service requests via phone, email, portal, and chat for client employees and their families. Educate callers on navigating and maximizing the value of their healthcare benefits and incentive programs.
Accountable for delivering sales results for health, life, and ancillary insurance products in the Southern Illinois and St. Louis territory. Focuses on building and expanding key broker relationships and identifying territory-specific growth opportunities.
Responsible for managing medical policies and programs while providing clinical leadership across medical management and population health initiatives. The role focuses on influencing quality, affordability, and risk adjustment accuracy through strategic provider-performance initiatives.
