The Coverage Review Representative answers inbound calls from members and healthcare providers to verify eligibility and explain prescription medication benefits. They are responsible for documenting interactions accurately and coordinating prior authorization requests within multiple systems.
The Patient Services Representative manages patient appointments and coordinates referrals while maintaining accurate documentation in healthcare systems. They serve as a primary point of contact for patients, providing compassionate support and clear communication regarding their care.
The Supervisor is responsible for coaching and developing customer service representatives to meet performance metrics and client expectations. They manage daily operations, handle escalated calls, and ensure team productivity through effective performance monitoring and reporting.
The Clinical Pharmacist serves as a client-facing subject matter expert providing evidence-based pharmacy strategies and utilization oversight. They are responsible for interpreting drug trends, developing clinical recommendations, and supporting sales teams through consultative client engagements.
The Clinical SME provides expert clinical guidance to internal and external stakeholders while developing educational materials and clinical guidelines. They also support clinical activities, facilitate training, and ensure alignment across cross-functional teams.
Process medical claims by reviewing documentation for accuracy, completeness, and policy alignment with CMS guidelines. Navigate multiple systems to verify pricing, authorizations, and determine whether to pay or deny claims.
The Assistant Manager of Operations provides leadership, coaching, and development to Senior Supervisors to ensure account performance and financial goals are met. They also identify process improvements and collaborate with workforce management to optimize staffing and service quality.
Handle incoming calls promptly and professionally while researching and providing effective resolutions to customer inquiries. Accurately document call details and communicate empathetically to meet team goals for quality and customer satisfaction.
You will provide consultative support to customers by assessing their needs and explaining Medicare and health plan options. You are responsible for building trusting relationships with members and guiding them toward the most appropriate insurance plans.
The Senior Manager of Operations is responsible for ensuring operational performance standards are met to drive client satisfaction, retention, and account profitability. They oversee daily operations, manage staff performance, and act as a liaison between the organization and clients to resolve issues and improve processes.
The supervisor will lead and motivate a remote team of telesales agents to meet performance goals and quality standards. They are responsible for providing real-time coaching, monitoring KPIs, and ensuring compliance with industry regulations.
The Credentialing Advocate supports the credentialing and recredentialing of healthcare providers by verifying credentials and maintaining accurate records. They also ensure compliance with regulatory standards and communicate with providers to resolve documentation discrepancies.
The Assistant Manager of Operations provides leadership and coaching to senior supervisors to ensure account performance and financial profitability. They are responsible for monitoring operating statistics, implementing process improvements, and optimizing staffing to meet client and organizational goals.
The Senior Manager of Operations is responsible for ensuring operational performance standards are met to drive client satisfaction, retention, and account profitability. They oversee daily operations, manage staff performance, and act as a liaison between the organization and clients to resolve issues and improve service quality.
The Credentialing Specialist is responsible for verifying provider credentials, maintaining accurate databases, and ensuring compliance with regulatory standards. They also manage re-credentialing applications and communicate effectively with providers regarding their status.
Care Coaches support adult patients by conducting health assessments and gathering patient information to help them navigate healthcare needs. They also facilitate care coordination, educate patients on benefits, and maintain accurate documentation within electronic systems.
The Senior Care Specialist will conduct telephonic health assessments and develop individualized care plans for members with chronic conditions. They will also coordinate care services, provide health coaching, and collaborate with multidisciplinary teams to improve health outcomes.
Conduct telephonic health assessments and develop individualized care plans for members with chronic or complex health conditions. Collaborate with multidisciplinary teams to coordinate care, provide health coaching, and support transitions of care.
Conduct telephonic health assessments and develop individualized care plans for members with chronic or complex health conditions. Collaborate with multidisciplinary teams to coordinate care, provide health coaching, and support transitions of care.
Conduct telephonic health assessments and develop individualized care plans for members with chronic and complex health conditions. Collaborate with multidisciplinary teams to coordinate care, provide health coaching, and support transitions of care.
Conduct telephonic health assessments and develop individualized care plans for members with chronic or complex health conditions. Collaborate with multidisciplinary teams and healthcare providers to coordinate care, support transitions, and promote improved health outcomes.
The Care Specialist handles inbound and outbound calls to process requests, conduct enrollment projects, and perform customer satisfaction surveys. They are responsible for routing messages to clinical staff, maintaining accurate patient charts, and ensuring all actions comply with HIPAA standards.
The supervisor will lead and motivate a remote team of telesales agents to meet performance targets and quality standards. They are responsible for providing real-time coaching, managing team schedules, and ensuring compliance with healthcare regulations.
The Program Management Support role is responsible for translating client requirements into production floor activities and managing supervisory teams to ensure operational efficiency. This position also oversees clinical management functions, quality compliance, and staff development to meet account performance and profitability objectives.
Lead and motivate a remote team of telesales agents to meet and exceed performance targets. Monitor KPIs and provide real-time coaching to improve sales behaviors and conversion rates.
The Sales Coach drives the performance of the sales team through individualized coaching, training, and the development of actionable feedback plans. They analyze performance data to identify trends and partner with leadership to implement strategies that boost productivity and efficiency.
The Supervisor is responsible for coaching and developing customer service representatives to meet and exceed client KPIs and CPIs. They manage employee performance through monitoring tools, handle escalated customer claims, and drive continuous improvement efforts within the call center.
