The Compliance Program Manager will monitor, research, and analyze federal and state healthcare regulations to assess their impact on the organization. They will lead enterprise-wide implementation initiatives and serve as a trusted advisor to operational teams regarding regulatory requirements.
The System Configuration Analyst will coordinate and track claims and utilization management projects while configuring and testing system logic. They will also partner with cross-functional teams to maintain benefit designs and ensure accurate operational outcomes.
Process dental claims, pre-authorizations, and referrals while ensuring accuracy and adherence to regulatory guidelines. Collaborate with internal teams to resolve claim-related issues and maintain high productivity standards.
The Provider Network Management Coordinator provides administrative and operational support to the Provider Relations team, including managing provider onboarding and credentialing. They also maintain network accuracy by coordinating communications, verifying provider data, and assisting with system-related projects.
The Director, IT Applications leads the delivery, support, and optimization of enterprise applications while fostering a culture of accountability and innovation. This role partners with business leaders to align technology roadmaps with organizational growth and ensures operational excellence across all application platforms.
The Account Executive II serves as a primary point of contact for clients, managing relationships and identifying opportunities for account growth. They lead renewal activities, analyze plan performance, and collaborate with internal departments to ensure exceptional service delivery.
The Account Executive II serves as the primary point of contact for a portfolio of clients, managing relationships and driving strategic account growth. They are responsible for analyzing plan utilization, leading renewal activities, and collaborating with internal teams to ensure exceptional service delivery.
The Clinical Operations Analyst will analyze clinical and operational data to drive business decisions and improve organizational workflows. They will also coordinate cross-functional initiatives and serve as a liaison between clinical teams and operational leadership.
The Operations Trainer designs, develops, and facilitates training programs to support operational excellence and employee development. They collaborate with department leaders to identify training needs, create learning materials, and provide ongoing coaching to improve performance.
The Operations Trainer is responsible for designing, developing, and facilitating training programs to support operational excellence across the organization. This role involves collaborating with department leaders to identify training needs, creating learning materials, and providing ongoing coaching to improve employee performance.
The Staff Dentist performs timely and clinically sound reviews of dental claims, prior authorizations, and treatment requests to ensure evidence-based care. They also collaborate with providers and internal teams to support quality improvement, regulatory compliance, and consistent coverage determinations.
The Staff Dentist will conduct utilization management and clinical reviews of dental claims, prior authorizations, and treatment plans to ensure evidence-based care. They will also collaborate with providers and internal teams to maintain clinical consistency and regulatory compliance across various lines of business.
The Senior Staff Dentist provides clinical leadership for utilization management and review programs to ensure appropriate dental care adjudication. They also engage in quality improvement initiatives, provider counseling, and clinical mentorship to support organizational compliance and performance goals.
The Staff Dentist will review dental claims and prior authorization requests to ensure clinical necessity and adherence to benefit policies. They will also participate in peer-to-peer consultations and collaborate with internal teams to maintain clinical quality and consistency.
The Quality Program Administrator manages Medicaid and Medicare quality programs by ensuring regulatory compliance and operational excellence. They facilitate cross-functional projects, analyze performance data, and prepare reports to drive continuous quality improvement.
The System Configuration Analyst will coordinate and execute claims and utilization management system configurations while ensuring alignment with benefit designs and regulatory standards. This role involves collaborating with cross-functional teams to test system logic, audit rules, and support new business implementations.
