The Sales Operations Service Agent provides high-quality support to brokers, agents, and members by resolving inquiries regarding eligibility, benefits, and claims. They also collaborate with the management team to address service-related projects and track quality performance metrics.
The Scheduling Liaison is responsible for managing and coordinating schedules to ensure efficient operations. This role involves acting as a primary point of contact for scheduling inquiries and maintaining accurate records.
The Sr ServiceNow Developer will design, implement, and maintain solutions on the ServiceNow platform while integrating with CI/CD pipelines and DevOps tools. They will also provide administrative support, manage vendor development work, and mentor the Service Management team.
Care Coordinators manage member caseloads and provide health navigation support to help members interact with the healthcare system. They perform outreach calls, conduct risk screenings, and document interactions within the designated health information system.
The Clinical Pharmacist supports quality measures for Medicare and Essential Plan populations through provider and member outreach to improve medication adherence. They also ensure clinical compliance with CMS and NYSDOH guidelines while collaborating with internal teams to resolve care gaps.
The Clinical Specialist manages member and provider complaints, grievances, and appeals while ensuring compliance with Federal and State regulations. They are responsible for clinical case development, resolution, and preparing cases for Medical Director review or external appeal processes.
The specialist is responsible for credentialing and re-credentialing providers, facilities, and vendors in accordance with regulatory requirements and company policy. They also facilitate vendor audits, prepare committee presentations, and ensure the accuracy of provider data in directories.
The Support Coordinator assists care managers with non-clinical tasks such as creating cases, conducting telephonic outreach, and managing service authorizations. They are responsible for documenting member and provider interactions while ensuring accurate communication across departments.
The Support Coordinator assists care managers with non-clinical tasks such as creating cases, conducting member outreach, and managing service authorizations. They are responsible for documenting member and provider interactions accurately while ensuring compliance with departmental requirements.
The Pharmacy Technician acts as a navigator to help members manage medication lists, eliminate barriers to therapy, and improve adherence. They collaborate with pharmacists and community partners to coordinate treatment plans and facilitate access to necessary medications.
The Care Coordinator manages a caseload of members to provide health navigation and care management services. They are responsible for conducting outreach, performing risk assessments, and documenting member interactions in the PHI system.
The Clinical UM Pharmacist reviews prior authorization requests for medications under the medical benefit and develops clinical criteria and medical policies. They also collaborate with prescribing physicians and Medical Directors to ensure clinical appropriateness and compliance with CMS and NYSDOH regulations.
The manager oversees clinical appeal inventory and staff assignments to ensure regulatory compliance and high-quality output during weekend shifts. They also manage vendor relationships, coordinate case escalations, and implement process improvements to meet production targets.
The Software Production Support Lead ensures the stability and performance of products by managing ticket escalations, performing root cause analysis, and coordinating with cross-functional teams. They are responsible for tracking SLAs, generating performance metrics, and providing technical guidance to resolve issues efficiently.
The Support Coordinator assists care managers with non-clinical tasks such as managing authorizations, creating cases, and conducting telephonic outreach to members and providers. They are responsible for maintaining accurate documentation, ensuring HIPAA compliance, and providing high-quality customer service to resolve member and provider inquiries.
The Clinical Specialist manages member complaints, grievances, and appeals by conducting clinical case development and resolution. They ensure compliance with federal and state regulations while managing caseloads and preparing cases for medical director review.
The analyst leads end-to-end forecasting and capacity planning for multichannel contact center operations, ensuring strategic alignment and performance oversight. They translate demand forecasts into actionable staffing strategies while driving continuous improvement in models and methodologies.
The Vendor Partner Specialist manages relationships with external vendors to ensure service level agreement adherence and quality auditing. They act as a liaison between department leaders and vendors to coordinate workflow, training, and process improvements.
