The Claims Processor II is responsible for the accurate and timely review, research, and resolution of moderately complex claims in accordance with contracts and policies. They also perform data coding, maintain claims files, and may provide training and feedback to new associates.
The Claims Processor III is responsible for the accurate review, research, and resolution of moderate to complex healthcare claims in accordance with established policies. They also serve as a technical subject matter expert, providing training, auditing, and support to team members.
The Customer Service Team Lead oversees the workload and performance of assigned staff to ensure timely, accurate, and compassionate service for members. This role involves mentoring staff, implementing process improvements, and managing operational workflows to meet company strategies.
The Manager of Case Management oversees clinical program operations, strategy implementation, and the continuous improvement of systems to meet business goals. They are responsible for leading, developing, and mentoring a team of clinical and support staff to ensure high-quality performance and regulatory compliance.
Conduct holistic health assessments and develop member-centric case management plans to improve health outcomes. Coordinate care among healthcare providers and use motivational interviewing to remove barriers to well-being.
Engage members with mental health or substance use disorders to conduct holistic health assessments and develop member-centric care plans. Coordinate with healthcare providers and use motivational interviewing to remove barriers to emotional well-being and health outcomes.
The Enterprise AI & Data Governance Analyst II will support the organization through AI & Data Governance policy creation, implementation, compliance monitoring, data lifecycle management, and reporting. This role involves collaborating with cross-functional teams to ensure adherence to governance policies and procedures while proactively identifying risks and opportunities.
