The Plan Document Coordinator prepares booklet-certificates and group policies for new, amending, and renewing client benefit plans. They are responsible for ensuring accurate documentation through the design system while managing complex, non-standard benefit provisions.
The Senior Manager, Clinical Review oversees the daily operations of the Clinical Review Department, including staff management and utilization management functions. They also analyze healthcare management data to identify trends, staffing needs, and risks to enhance departmental efficiency.
This role is responsible for designing, testing, and implementing new systems, programs, and processes to meet business objectives. The analyst will also manage enhancements to existing systems while collaborating with management and subject matter experts.
The Technical Eligibility Analyst is responsible for managing eligibility processes in a fast-paced, production-driven environment. They must effectively communicate with members, providers, and clients while maintaining high data accuracy and resolving complex issues.
The Implementation Manager leads the implementation phase for new clients and complex renewals while coordinating cross-functional operational teams. They are responsible for mitigating client and internal risks and facilitating operational procedures in partnership with Sales and Client Management teams.
The Technical Eligibility Analyst performs technical tasks such as loading Triple E files and managing manual eligibility updates. They also provide quality service by accurately modifying eligibility data and responding to inquiries from members and clients.
The Claim Supervisor manages a team of Claim Analysts to ensure production, quality, and service expectations are met. They are responsible for staff development, client implementation, and resolving complex claim inquiries.
The Customer Service Representative will resolve customer issues accurately while navigating multiple systems and providing service excellence. They are responsible for maintaining high standards of communication and efficiency in a fast-paced, structured environment.
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 COBRA Analyst oversees all aspects of the client and member experience, including benefit elections, payments, and reporting for COBRA, FMLA, and leave programs. This role involves managing inbound and outbound communications via phone, email, and fax with clients, members, and third-party affiliates.
The Strategic Reporting Consultant defines and executes the end-to-end reporting strategy across all lines of business to ensure data accuracy and alignment with business objectives. This role acts as a strategic advisor to leadership and clients, translating complex data into actionable insights while leading cross-functional teams to deliver high-value reporting roadmaps.
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 life and disability information to make benefit determinations and provide guidance to team members regarding processing procedures.
The Sr. Reinsurance Administrator is responsible for the accurate and timely filing of excess risk claims and handling complex stop-loss claim situations. They also assist with reporting initiatives, testing, and training new reinsurance analysts.
Benefit Advocates manage and coordinate high-volume service requests via phone, email, and chat to assist employees with their healthcare benefits. They educate callers on benefit plans and provide guidance to help them maximize the value of their employer-provided incentive programs.
The Intake Coordinator is responsible for accurately and respectfully triaging inquiries from members, providers, and clients via phone, email, and electronic systems. They handle various tasks including pre-certification requests, benefit verification, and status updates while maintaining high service standards.
Provides telephonic support to clients to help them navigate healthcare, wellness, and incentive programs. Resolves complex benefit and claim issues while coordinating with providers and insurers.
Provide quality service by responding to high-volume telephonic, written, and electronic inquiries regarding benefits, eligibility, and claim status. Accurately document all actions and navigate multiple system applications to resolve member and provider issues.
Supervise and manage a remote team of inbound and outbound customer service representatives to ensure exceptional service delivery. Focus on achieving client service expectations, meeting service objectives, and fostering staff development.
Supervise and manage a remote team of inbound and outbound customer service representatives to ensure exceptional service delivery. Responsible for meeting client service expectations, achieving health benefits objectives, and overseeing staff development.
Manage and coordinate a high volume of service requests via phone, email, portal, and chat for client employees and their families. Educate callers on navigating and maximizing the value of their healthcare benefits and incentive programs.
Responsible for the accurate filing of excess risk medical claims and coordinating with stop loss carriers for reimbursements. The role involves managing appeals, distributing reports, and notifying stakeholders when claimants reach specific deductible thresholds.
