The Technical Eligibility Analyst is responsible for managing eligibility processes in a fast-paced, production-driven environment. They must ensure data accuracy while collaborating effectively with clients, providers, and internal management teams.
This role supports strategic and analytical projects, including divisional planning and business strategy development for retail markets. The incumbent will interface with various business teams to align project outcomes with the overall company strategy.
The Claims Recovery Examiner is responsible for researching refund checks, out of balance entries, and non-negotiated checks. This role involves taking actions such as offsetting, voiding, or reissuing provider checks based on complex pricing and contract guidelines.
The Sr Sales Executive is responsible for delivering sales results for health, life, and ancillary insurance products within a defined territory. They will build and expand broker relationships, provide sales support through education, and identify growth opportunities to meet assigned goals.
The posting refers applicants to Carla Hwang for the job description and does not provide specific day-to-day responsibilities. The role requires coordinating, managing, and facilitating projects, including process flow-charting.
The Manager of Market Finance is responsible for market-level financial reporting, planning, and performance management across a region. They partner with operations leaders to translate performance into actionable insights and drive outcomes in value-based healthcare programs.
The Claims Examiner is responsible for reviewing and processing healthcare claims to ensure accuracy and compliance. They contribute to the team's goal of making healthcare simpler and more affordable for members.
The analyst develops and maintains reporting and analytical solutions to support Medicare Stars performance and quality outcomes. They conduct detailed performance analyses, identify trends, and provide actionable insights to support strategic clinical and operational initiatives.
This role is responsible for developing, integrating, testing, and maintaining both new and existing software applications. The engineer will utilize various development methodologies and programming languages to deliver high-quality technical solutions.
The Senior Consultant leverages technical skills and healthcare industry knowledge to provide analytical support and consultancy to clinical and business stakeholders. They are responsible for leading analytic initiatives and providing advisory services to senior leadership.
The role involves providing telephonic and field-based care coordination to members to address their health needs and goals. Responsibilities include conducting health screenings, comprehensive assessments, and care planning for complex and specialty populations.
Manage clinical pharmacy activities within the Medicare program and support the development and execution of initiatives that improve the quality and cost-effectiveness of drug therapy. Coordinate with ambulatory care providers and clinical teams, and travel regionally to support assigned provider groups.
Analyze and support enhancements and new capabilities for a critical claims application, defining functional, non-functional, and systems requirements for development teams. Facilitate requirements, design, and code reviews, and help plan system integration and user acceptance testing and releases in collaboration with business, QA, and IT teams.
This role functions as an internal consultant and program manager to drive marketing, strategy, and business development initiatives. The incumbent will analyze performance data and member experience to provide actionable recommendations for strategic decision-making.
This role involves providing telephonic and field-based care coordination to members to address their health needs and goals. The manager will conduct comprehensive health assessments, care planning, and support clinical operations through member and provider engagement.
This role is responsible for ensuring compliance with utilization management and quality review functions within the health plan. Responsibilities include performing medical necessity reviews, benefit determinations, and developing clinical documentation to support coverage decisions.
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 while supporting clinical operations and provider activities.
This role provides direct support to senior leadership by managing operational initiatives, tracking business metrics, and coordinating strategic priorities. The specialist serves as a key liaison between internal stakeholders and IT while preparing executive-level communications and reports.
This role is responsible for initiating and coordinating the request for proposal (RFP) process while ensuring high-quality service and adherence to company policies. The associate will draft response materials and collaborate with various departments to resolve issues and meet customer specifications.
This position is responsible for designing enhancements and new business applications or information systems solutions by integrating technical and business requirements. The role serves as a technical designer to identify the best solutions and define technical specifications within the code environment.
This position supports the development of divisional strategies and identifies tools to track strategic opportunities. It involves end-to-end report development and interfacing between business and technical teams to achieve desired outcomes.
Provide telephonic and field-based care coordination to members to address personal health needs and health goals. Conduct comprehensive health assessments and care planning while supporting clinical operations and provider activities.
The QOC Nurse conducts timely reviews and investigations of potential quality of care issues in accordance with state and federal regulatory requirements. They are responsible for performing quality improvement activities and communicating findings to leadership, providers, and cross-functional stakeholders.
This role acts as a concierge to divisional analytics teams to help define and execute data strategies. The position coordinates the development and delivery of data assets while serving as the primary point of contact for business stakeholders.
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 communicating progress to senior management.
The Senior Systems Analyst oversees the strategy, planning, and delivery of data and analytics platform technologies. They are responsible for managing requirements and ensuring effective system performance within an Agile development environment.
This role involves auditing clinical, billing, and coding services to validate claims using medical, contractual, and legislative information. The auditor will also coordinate with various departments and prepare detailed documentation of findings.
This position is responsible for auditing and reviewing electronic clinical records to ensure compliance with regulatory and accrediting mandates. It involves overseeing the extraction of clinical data from EMRs and auditing supplemental files to support HEDIS and other quality measures.
This role serves as a functional liaison between intake and operations teams to support Medicare and Star Ratings business initiatives. The consultant reviews project scope, manages system change requests, and facilitates communication of operational updates to ensure successful project delivery.
This role involves monitoring and analyzing national, state, and federal legislative and regulatory activities to support business operations. The consultant will collaborate with legal and government relations teams to prepare summaries and educate internal stakeholders on relevant legal requirements.
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 to optimize product coverage and act as a subject matter expert for integrations.
This role assists in leading divisional short-term and long-term planning for the Medicare Advantage Bid process. The consultant produces value-add analytics to influence bid strategy, goal setting, and enterprise growth outcomes.
This role is responsible for the on-site or territorial support of assigned accounts, focusing on membership retention and service delivery. The manager will implement healthcare-related activities, conduct training sessions, and ensure client satisfaction through effective issue resolution.
This position is responsible for conducting care management and health education programs for customers on government health care programs. The role involves gathering and analyzing data for regulatory reports and representing the company to members.
The Manager of FP&A will lead financial planning, forecasting, and reporting processes to support business objectives and value-based care contract performance. This role involves collaborating with executive leadership to drive financial initiatives, process improvements, and strategic growth opportunities.
Lead and support complex short- and long-term Medicare Advantage provider network initiatives from inception through completion, using internal and external data to prioritize work and track progress. Partner with divisional leadership on business plans and strategy, and present network trends and insights to cross-functional teams and senior leaders.
The architect ensures project designs align with the application architecture roadmap and supports teams on technical design activities. They also define interactions between systems and act as a subject matter expert for product integrations.
The Application Architect will design and deliver scalable enterprise solutions to optimize claims adjudication and payment integrity within healthcare platforms. They will serve as a subject matter expert, guiding complex solution designs and aligning technical strategies with business objectives.
The representative will develop and maintain cooperative relationships with healthcare providers to support network performance and facilitate ease of business. They are responsible for issue resolution, provider education, and evaluating performance against operational and financial requirements.
The Sr Proposal Writer leads the development of complex, national Request for Proposals (RFPs) by collaborating with internal stakeholders to create persuasive, high-quality content. This role involves managing multiple projects simultaneously, ensuring compliance with client requirements, and mentoring junior staff to streamline the proposal process.
This role is responsible for 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 interpret complex trends within datasets.
This role is responsible for driving Medicare product sales growth by managing relationships with brokers, agencies, and community partners. The associate will execute sales strategies, conduct training, and monitor performance metrics to ensure compliance with CMS guidelines.
This role is responsible for aligning project designs with the application architecture roadmap and supporting technical design activities. The architect will act as a subject matter expert for product integrations and define interactions between application packages, databases, and middleware.
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.
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 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.
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.
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.
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 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.
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.
