The Appeals & Grievances Specialist manages and resolves complex member complaints, grievances, and appeals to ensure regulatory compliance and high-quality outcomes. The role involves performing advanced case analysis, providing guidance to team members, and identifying systemic process improvements.
The Technology Delivery Manager oversees the end-to-end delivery of technical solutions by bridging the gap between software engineering, product teams, and business stakeholders. This role is responsible for managing workflows, resolving complex technical issues, mentoring staff, and ensuring projects are completed on time and within budget.
The Case Manager provides telephonic, member-centric care coordination for Medicare Advantage Dual Special Needs Plan members to navigate the healthcare system. Responsibilities include conducting health risk assessments, developing comprehensive care plans, and collaborating with providers to support social determinants of health.
The Engagement Coordinator II conducts high-volume outbound telephonic outreach to connect members with care coordination and health support services. They serve as a primary point of contact to assess member needs, educate on benefits, and facilitate access to healthcare resources.
The specialist collects, reviews, and manages medical records to support clinical reviews, quality programs, and regulatory audits. They coordinate with provider offices and internal teams to ensure documentation accuracy, completeness, and compliance with privacy standards.
The coordinator performs intake, case entry, and routing for member and provider appeals and grievances to ensure timely and accurate processing. They also provide information regarding procedures and timelines while maintaining compliance with regulatory and organizational standards.
Care Coordinators manage a caseload of members to create individualized care plans and coordinate 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 track member progress.
Care Coordinators manage a caseload of members to create individualized care plans and coordinate the delivery of medical and social services. They serve as a primary contact for members, providing education on benefits and partnering with providers to ensure quality care.
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.
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.
