The specialist manages inbound provider demographic requests via email and Salesforce to ensure accurate and timely system updates. They also handle physician inquiries regarding contract status and maintain organized documentation for provider data.
The Supervisor leads the Medical Management Support team and oversees non-clinical operations, including staff supervision, workflow management, and process improvement. They collaborate with clinicians and leadership to ensure regulatory compliance and timely, accurate service delivery.
The Supervisor, Utilization Management oversees the utilization management team, ensuring programs and processes meet regulatory and business standards. They are responsible for staff supervision, performance evaluations, quality assurance audits, and coordinating daily operations to ensure efficient service delivery.
The Facilities Mailroom Team Lead oversees daily mailroom operations, ensuring accurate and secure processing of correspondence while providing leadership to staff. This role also coordinates with vendors, manages inventory, and supports process improvements to maintain an efficient work environment.
The Supervisor, Case Management oversees a team of case managers, ensuring quality program initiatives, billing audits, and adherence to clinical policies. They also facilitate training, manage caseloads, and collaborate with leadership to improve service delivery and resolve member complaints.
The Benefit Review RN is responsible for performing utilization reviews and coordinating independent physician review requests for group health plan members. They will assess clinical data, facilitate treatment plan coordination, and provide patient education while adhering to internal policies and regulatory standards.
The Assistant General Counsel assists the Chief Legal Officer in implementing corporate legal initiatives and providing legal support across various departments. Responsibilities include researching regulatory compliance, managing legal risks, and negotiating contracts for the company and its clients.
The Member Advocacy Support Specialist manages a caseload of terminated account members to guide them through the balance bill defense process. They act as a primary point of contact to coordinate issue resolution between members, clients, providers, and legal teams.
The Clinical Intake Specialist manages the notification process for medical services by utilizing electronic systems and following established policies. They provide non-clinical support, handle telephonic intake, and ensure accurate documentation in compliance with HIPAA and other regulatory standards.
The Upland Advocate manages a caseload of employees to help them navigate financial assistance programs, negotiate medical bills, and research discounted care options. They serve as a liaison between employees and providers while maintaining meticulous documentation and providing high-touch concierge support.
The Member Benefits Specialist acts as a primary point of contact for members, providing support and expertise regarding benefit plans and healthcare navigation. They are responsible for resolving member inquiries, conducting research, and ensuring accurate documentation while maintaining HIPAA compliance.
The associate will build relationships with clients and members to identify needs and facilitate innovative solutions for engagement. They will also serve as a member advocate, managing caseloads and coordinating issue resolution with internal and external stakeholders.
The Member Benefits Specialist acts as a primary point of contact for members, providing support and education regarding healthcare benefits and plans. They are responsible for resolving inquiries, conducting research, and maintaining accurate documentation while ensuring compliance with HIPAA regulations.
The associate will build relationships between clients, members, and stakeholders to drive engagement and success. They will also manage member caseloads and provide advocacy throughout the member journey to ensure timely issue resolution.
The Lead Plan Document Administrator oversees the preparation and administration of plan documents, amendments, and summary plan descriptions while ensuring compliance with legal and HIPAA requirements. This role also provides functional leadership, coordinates team production, and implements process improvements to maximize operational efficiency.
The Regional Sales Coordinator provides administrative and coordination support to the sales team, including managing logistics, documentation, and follow-up activities. They act as a liaison between sales teams, back-office operations, and external stakeholders to ensure operational efficiency and effective information flow.
The Manager of Case Management provides strategic leadership and mentorship to the team while overseeing program strategy, quality assurance, and accreditation compliance. They are responsible for managing staff performance, driving operational transformation, and collaborating with cross-functional partners to ensure high-quality patient care.
The Plan Document Specialist is responsible for drafting, restating, and amending plan documents and summary plan descriptions to ensure compliance with state and federal laws. They act as a liaison between clients, brokers, and internal teams to facilitate the implementation of new benefit structures.
The Relationship Manager is responsible for maintaining client satisfaction, managing the onboarding process, and ensuring the retention of assigned employer and broker portfolios. They act as a trusted advisor, coordinating internal support services and educating clients on benefit plan designs and program analytics.
The Manager leads a team of onshore and offshore resources to oversee healthcare and pharmacy data quality, reconciliation, and audit controls. They are responsible for ensuring the integrity of EDI transactions and pharmacy claims while driving continuous improvement and vendor accountability.
The Manager leads a team of offshore auditors to validate US healthcare plan configurations against approved documents and coding standards. They are responsible for driving audit consistency, defect prevention, quality metrics, and stakeholder communication across the Enterprise Quality Assurance organization.
The Stop Loss Nurse identifies, monitors, and manages high-cost medical claims to ensure policy compliance and cost-effective care. They collaborate with internal teams, TPAs, and carriers to implement cost-containment strategies and provide accurate reporting on financial exposure.
The Supervisor will oversee TPA client new business and renewal implementations to ensure milestones align with readiness and production goals. They will also lead internal status discussions, manage cross-functional accountability, and identify opportunities to improve workflow efficiency using AI-enabled tools.
The Senior Operations Specialist will lead end-to-end EDI implementation efforts for new TPA partnerships, managing timelines and cross-functional coordination. They will also serve as the primary operational owner for assigned accounts, monitoring performance and driving process improvements.
The Manager, Care Advocacy oversees contact center service metrics, staff performance, and the development of member-centric strategies to ensure an elevated experience. They are responsible for coaching team members, driving operational efficiencies, and collaborating with leadership to analyze performance trends.
The specialist is responsible for reviewing and validating PBM vendor invoices to ensure accuracy and compliance with contractual agreements. They reconcile billed fees against claims data and coordinate with vendors and internal managers to resolve billing discrepancies.
The Supervisor oversees escalated member issues and supervises staff managing written benefit-related inquiries, ensuring timely, accurate, and high-quality responses while maintaining service standards. This role involves providing daily guidance, coaching, quality oversight, and operational support to ensure team efficiency and adherence to service expectations.
