This role supports provider recruitment and contracting processes to ensure network adequacy within an assigned territory. Responsibilities include performing gap analysis, developing remediation plans, and assisting with complex hospital and physician contracting activities.
This role supports the evaluation of Medicare regulatory requirements and CMS guidance to assess compliance risks within government contracts. The consultant will act as a subject matter expert to ensure regulatory requirements are implemented across internal operations and delegated entities.
This role involves creating reports, insights, and analytics to support divisional strategic initiatives and business needs. The consultant will interface between business and data teams to build actionable tools and lead cross-functional teams to address complex business problems.
This role is responsible for 24x7 infrastructure support services across production and non-production environments. It involves utilizing analytics to improve service availability, managing vendor performance, and handling incident resolution.
This role involves designing enhancements and new business applications by integrating technical and business requirements. The incumbent will serve as a technical designer to identify optimal solutions and bridge the gap between business needs and architectural definitions.
The Clinical Pharmacist manages pharmacy programs, including formulary development, utilization management, and medication therapy management for Medicare members. They collaborate with multidisciplinary teams to conduct comprehensive medication reviews and improve the quality and cost-effectiveness of drug therapy.
The role involves providing service to subscribers within a prescribed territory and promoting enrollment growth among federal employees. The representative acts as a liaison between members, federal agencies, and the company.
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 driving Medicare sales growth by managing relationships with brokers, agencies, and community partners within the Central and Coastal South Carolina territory. Responsibilities include recruiting new agency partners, conducting sales presentations, and monitoring performance metrics using Salesforce CRM to ensure compliance with CMS guidelines.
This position is responsible for developing, integrating, testing, and maintaining both existing and new applications. The role involves designing application features and ensuring compliance with organizational quality standards.
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 role leads business analysis and ensures alignment across functional areas to support complex, enterprise-wide strategic initiatives. It involves coordinating project teams, managing budgets, and interacting with senior management to drive project completion.
The role is responsible for driving profitable Medicare membership growth by managing relationships with brokers, agencies, and providers. It involves executing sales strategies, conducting training, and monitoring performance metrics to meet organizational goals.
This role leads the execution of complex labor relations initiatives, including collective bargaining agreement administration and grievance resolution. It serves as a senior subject matter expert providing technical leadership and labor risk mitigation across the enterprise.
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.
This role involves planning and managing a team of analysts to provide business intelligence support and strategic data-based recommendations. The manager will lead complex analytical initiatives and ensure departmental policies align with the corporate vision.
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 consultant is responsible for designing, implementing, and managing database assets within cloud environments using enterprise automation and monitoring tools. They will customize cloud systems to meet performance, maintenance, and security requirements while establishing best practices for automation.
The auditor is responsible for reviewing clinical, billing, and coding services to validate claims pre and post payment. They must coordinate with various internal departments and document findings to ensure compliance with medical and legislative policies.
The analyst is responsible for investigating and resolving Medicare Part D complaints while ensuring CMS regulatory compliance. They will also support audit activities, manage drug recall communications, and coordinate emergency access-to-benefits processes.
This role involves providing telephonic and field-based care coordination to members to address their personal health needs and goals. The manager will conduct health screenings, comprehensive assessments, and care planning for complex and specialty populations.
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 specialist is responsible for complex contracting of dentists within an assigned territory to achieve annual network growth goals. They will conduct outreach, manage initial relationship development, and perform financial negotiations with dental providers.
This role is responsible for developing, supporting, and maintaining automation solutions using UiPath and Azure AI platforms. The specialist will collaborate with stakeholders to translate business requirements into scalable, high-quality technical solutions.
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.
Lead the development of technical and analytical enhancements to improve Medicare Part D Star ratings. Design advanced reporting and dashboards to support critical business decisions regarding clinical, administrative, and customer experience measures.
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.
Manage the implementation and analysis of actuarial models for pricing, reserving, and forecasting. Develop complex models and lead projects across various departments to drive informed decision-making.
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.
