The Member Experience Guide acts as a primary point of contact for members, managing inquiries from start to finish with empathy and accountability. They are responsible for resolving member issues, explaining complex benefits, and advocating for service improvements to ensure a high-quality experience.
The peer advocate will conduct outbound calls to members to provide support, guidance, and advocacy based on health interventions. They will build rapport using personal lived experiences to coach members on health strategies and encourage positive behavior changes.
The Member Experience Guide acts as a primary point of contact for members, managing inquiries from start to finish with empathy and accountability. They are responsible for resolving complex issues, providing clear guidance on benefits, and advocating for process improvements to enhance the overall member experience.
This role identifies and quantifies total cost of care savings opportunities by applying data science and AI-enabled analytics to claims, clinical, and contract data. The incumbent collaborates with cross-functional stakeholders to translate analytic findings into actionable medical cost management strategies.
The Advanced Practice Clinician provides primary care to members in their residences, including wellness exams, chronic disease management, and diagnostic testing. They collaborate with case management and primary care physicians to ensure continuity of care and address clinical quality gaps.
The Care Coordinator will assess, plan, and monitor the holistic needs of members to support their health and independence. They will act as a primary point of contact for members and providers to troubleshoot access issues and coordinate care services.
The Broker Account Executive is responsible for overseeing, training, and servicing the broker distribution channel to achieve sales targets for Medicare Advantage plans. This role involves managing relationships with agencies, conducting broker education, and ensuring compliance with federal and state regulations.
The Senior Accountant manages financial transactions, reconciliations, and regulatory compliance for the Medicare Part D pharmacy program. They collaborate with internal and external stakeholders to provide accurate financial reporting and support operational decision-making.
Coordinate high-quality care for members by managing authorizations, conducting utilization reviews, and facilitating discharge needs from acute and skilled nursing settings. Serve as the primary point of contact for patients, families, and providers to ensure timely delivery of services and medical supplies.
Leads end-to-end provider data operations to ensure a single source of truth for provider intelligence across the enterprise. Drives strategy for data accuracy, governance, and AI-enabled automation to support regulatory compliance and operational efficiency.
Oversee the design and implementation of the Part D program, ensuring CMS compliance and operational excellence for a senior-focused Medicare Advantage Plan. Manage the contracted pharmacy benefit manager (PBM) and lead the Pharmacy Experience & Access team to optimize member experience and clinical operations.
Serve as the primary point of contact for members regarding benefits, eligibility, claims, and referrals. Ensure member satisfaction by providing quality customer service and resolving issues efficiently while adhering to regulatory guidelines.
Lead the pharmacy operations team to ensure regulatory compliance with CMS and other state requirements regarding prescription drug benefits. Oversee PBM operations, manage Part D reporting, and drive departmental goals through cross-functional collaboration.
The Broker Account Executive is responsible for overseeing, training, and servicing the broker distribution channel to achieve sales targets for Medicare Advantage plans. This role involves maintaining relationships with agencies, ensuring regulatory compliance, and coordinating broker education and marketing campaigns.
