The Care Coordinator manages a caseload of members by creating individualized care plans and coordinating the delivery of medical and social services. They also serve as a primary contact for members, providing education on benefits and partnering with providers to ensure quality care.
The role involves managing claim appeals, inquiries, and correspondence while researching and resolving payment discrepancies. The employee will collaborate with cross-functional teams to ensure accurate claim outcomes and maintain operational efficiency.
The Claims Processor III is responsible for the accurate and timely adjudication of complex commercial and individual medical claims from receipt through final resolution. This role involves analyzing claim scenarios, applying standard operating procedures, and collaborating with internal and external partners to ensure accurate outcomes.
The specialist manages and resolves complex member complaints, grievances, and appeals while ensuring regulatory compliance and accurate documentation. They also provide guidance to team members and support the resolution of high-visibility or executive-level inquiries.
The Customer Service Representative acts as the primary contact for members to resolve inquiries regarding claims, enrollment, billing, and pharmacy benefits. They are responsible for providing high-quality service and utilizing service recovery processes to assist members in complex situations.
The Coding Analyst II performs high-level coding, auditing, and analysis to ensure accurate application of medical coding standards within claims and operational workflows. They also collaborate with cross-functional teams to resolve coding-related issues and support data integrity and payment accuracy.
The Claim Accumulator II is responsible for maintaining and updating member accumulators by processing daily inventory reports and system changes. This role involves researching discrepancies, collaborating with internal stakeholders and vendors, and ensuring the accuracy of medical and pharmacy claims data.
Care Coordinators manage a caseload of members to create individualized care plans and coordinate the delivery of medical and social services. They also provide education on benefits and serve as a primary contact for members while partnering with providers to track progress.
The Broker Experience Representative serves as the primary point of contact for broker partners, providing support for enrollment, eligibility, and marketing inquiries. They collaborate with internal teams to resolve operational issues and maintain strong, positive relationships with partners.
Drive new business sales by managing strategic relationships with brokers and consultants for commercial large group business. Develop strategic sales plans and lead RFP responses to provide tailored healthcare solutions for clients.
