The Communications and Engagement Specialist manages custom member education campaigns by developing content, deploying strategies, and tracking success rates. They collaborate with HR leaders and brokers to deliver effective communications while overseeing vendor coordination and digital engagement initiatives.
The Sr. Plan Document Specialist is responsible for drafting, reviewing, and maintaining employee benefit plan documents and Summary Plan Descriptions for self-funded health plans. They serve as a subject matter expert to ensure compliance with federal regulations while collaborating with internal stakeholders to deliver accurate documentation.
The Medical Claims Auditor reviews professional and facility claims for accuracy, compliance, and contractual adherence. They analyze medical records and itemized bills while applying appropriate coding rules and reimbursement methodologies.
The supervisor oversees escalated member issues and manages staff handling written benefit-related inquiries, including claims and eligibility. They provide daily coaching, quality oversight, and workflow coordination to ensure team efficiency and adherence to service standards.
The Claims Examiner is responsible for processing medical, dental, and vision claims while ensuring compliance with plan provisions. They also manage inquiries, resolve issues, and maintain accurate documentation within the system.
The Relationship Manager is responsible for overall client satisfaction, managing the onboarding process, and providing superior service to brokers and employers. They act as a liaison between internal staff and clients while identifying revenue opportunities and ensuring successful plan renewals.
The Intake Specialist serves as the primary point of contact for members, managing initial file setups and balance bill inquiries. They are responsible for accurate data entry, coordinating with internal teams and third-party partners, and ensuring timely resolution of service issues.
The Member Services Advocate manages a caseload to provide advocacy, education, and case management for members navigating the balance bill defense process. They act as the primary point of contact to coordinate issue resolution between members, clients, legal teams, and medical providers.
The Growth Data Operations Manager oversees data workflows, governance, and quality to support sales and revenue operations. They manage CRM data, territory assignments, and AI-assisted workflows to drive revenue and ensure operational accuracy.
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.
