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Manage and resolve complex accounts receivable, primarily Workers' Compensation claims, while also handling Auto Liability and Personal Injury accounts through follow-up, denial resolution, appeals, and payment research. Meet daily productivity and accuracy targets, support escalations and training, respond to calls and correspondence, and maintain confidentiality and compliance.
Elicit and manage business and functional requirements, translate them into user stories and acceptance criteria, and maintain traceability from business needs through test coverage. Lead QA strategy and test execution across releases, manage defects and quality metrics, expand test automation, and collaborate with stakeholders and delivery teams in Agile/Scrum.
Connect with prospective customers, assess their needs and risks, and recommend personalized auto, home, life, disability, and related insurance solutions. Manage leads and the sales pipeline in Salesforce, build customer and referral relationships, and participate in coaching and team activities while meeting production goals.
Design, build, and maintain scalable backend systems and high-impact decisioning features using Python and Django, while ensuring reliability through automated testing and resolving complex technical bottlenecks. Partner across teams, lead code reviews, mentor engineers, and use AI-assisted development to accelerate delivery.
Reviews and adjudicates complex medical claims, applying coverage and medical necessity guidelines, verifying eligibility, ensuring compliance, and identifying payment discrepancies or irregularities. Provides guidance and training to colleagues, resolves member inquiries, and contacts parties to obtain information needed for claims or reconsiderations.
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Analyze and map operational processes to identify inefficiencies, bottlenecks, waste, and root causes, then design and document improved workflows. Test and implement process changes, build cost-benefit cases, establish performance monitoring, support capacity and throughput planning, and collaborate with operations, automation, and IT teams.
Manage provider enrollment, recredentialing, revalidation, and payer readiness for individual providers and healthcare facilities across commercial and government payers. Maintain accurate enrollment records, advise clients on payer setup and billing compliance, resolve enrollment issues, and report on status, deadlines, and audit findings.
Lead process automation delivery by managing process engineering and execution project management teams, overseeing process analysis and improvement, and developing business cases. Manage deployment, cutover, and stabilization while aligning process design with solution architecture, tracking program outcomes, escalating risks, and maintaining the execution roadmap.
Supervise, train, mentor, and evaluate billing staff while monitoring productivity, quality, and team performance. Oversee healthcare billing processes, resolve escalated client issues, support workflow improvements, and ensure compliance with company policies and HIPAA.
Evaluate provider requests for medical necessity across inpatient, outpatient, authorization, retrospective, out-of-network, and treatment-setting reviews, applying clinical criteria, policies, benefits, and contracts. Document decisions, consult Medical Directors when needed, support compliant and timely utilization management, and collaborate with internal teams to promote appropriate care and quality improvement.
Provide remote nursing support for surgical and orthopedic clinic patients, including assessments, point-of-care testing, clinical documentation, patient education, and communication with providers and the care team. Coordinate referrals, testing follow-up, surgical scheduling, prior authorizations, and preoperative and postoperative patient communications.
Delivers remote prescription processing and clinical pharmacy services, including medication reviews, patient consultations, immunizations, and adherence programs. Ensures regulatory compliance and quality improvement while supporting pharmacy financial goals and providing expertise to pharmacists and field leaders.
Partner with Product Managers, Engineering, and Architecture to align product roadmaps with business goals, prioritize backlogs, and translate business needs into actionable technical requirements. Support life insurance system modernization and policy data conversions, coordinating validation, testing, cutover, and operational readiness while tracking outcomes and risks.
Migrate, update, synchronize, and reconcile customer and operational records between BodyShop Booster and external systems, including collision-industry platforms such as CCC ONE. Protect confidential information, document completed work and exceptions, resolve discrepancies, and help improve migration workflows and quality-control procedures.
Lead and develop a regional talent acquisition team, partnering with operational leaders to align recruiting strategies with business needs and deliver a strong candidate and hiring leader experience. Build talent pipelines, use market and recruiting data to guide workforce planning, strengthen employer branding, ensure compliance, and manage recruiting vendors and technology adoption.
The Senior Director leads the professional services sales function to achieve revenue targets while defining and governing solution architecture practices. This role provides strategic leadership to ensure consistent, scalable, and high-value solution delivery across the enterprise insurance market.
Investigate and evaluate heavy equipment and truck damage claims, verify coverage, inspect damage, and prepare or review repair estimates and total-loss valuations. Negotiate and resolve claims with customers, attorneys, and repair facilities, set reserves, issue authorized payments, and support the claims team with technical guidance.
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Assess members’ behavioral health needs and guide them and their families to appropriate care and community resources. Develop or support care plans, address barriers to effective care, and monitor progress toward desired outcomes through ongoing assessments and evaluations.
Lead the Network’s cost accounting operations, including staff management, consistent cost definitions and allocation methods, and the production of accurate patient-care cost information. Use analytics and decision-support tools to inform clinical and financial decisions, support reimbursement discussions and capital planning, and collaborate with leaders and departments to explain and maintain credible cost data.
Lead new product introductions and technology transfers from the New Hampshire design center to high-volume manufacturing sites in Asia, preparing production lines, supply chains, and teams for launch. Coordinate cross-functional execution, qualification builds, schedules, risks, and stakeholder communications to meet quality, customer, and business objectives.
Build and lead an enterprise-wide member journey management practice, coordinating cross-functional teams to design, deliver, measure, and continuously improve member experiences. Guide digital portal and mobile app roadmaps, sponsor the Member 360 data strategy, and align experience initiatives with healthcare quality outcomes and regulatory requirements.
Provide clinical and technical support for neuromodulation and targeted drug delivery therapies during procedures and patient follow-ups, including device selection, programming, testing, and troubleshooting. Educate patients and healthcare professionals, manage territory accounts and inventory, and contribute to sales goals, training, and compliance requirements.
Lead, coach, and develop the Central Region sales team, delivering regional sales and gross profit targets while managing operational expenses and team performance. Build strong relationships with education customers and internal stakeholders, using customer and market insight to improve outcomes and contribute to commercial strategy.
Process, review, adjust, and resolve moderate-to-complex claims while meeting quality, turnaround-time, compliance, and performance standards. Respond to claims inquiries, investigate potential fraud, coordinate payment liability with other insurers and Medicare, and contribute to process improvements and project teams.
Analyze funding variances, reconcile payments, monitor settlement activity, and resolve account and payment discrepancies while identifying fraud risks and preventing financial loss. Prepare chargeback documentation, collaborate with store and external partners, support accurate reporting and audits, and recommend improvements to reconciliation processes and internal controls.
Conduct mental health assessments remotely by telephone or video and recommend evidence-based treatments in line with NICE guidelines and relevant policies. Work independently under clinical supervision as part of a clinical team, liaising with internal services and external organizations.
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Support regional execution teams and major commodity programs by maintaining accurate information in the Corrigo CMMS database and serving as the Vendor Management group’s main point of contact for CMMS matters. Oversee schedule data and contract amendment requests, prepare progress reports, manage the shared mailbox, and maintain Specialty Dispatch tables.
Prepare monthly client financial statements, reporting packages, variance explanations, and supporting documentation, and complete bank reconciliations and balance sheet analysis. Manage lease records, tenant billing, cash and accrued expense accounting, month-end close, operating expense reconciliations, and ad hoc reporting.
Lead financial control and advise the account director, overseeing the finance team, accounting processes, budgets, forecasts, cash management, and financial reporting for a global real estate services account. Coordinate with regional finance leaders and client accounting teams to maintain compliance, identify financial risks and opportunities, improve processes, and develop staff.
Review provider enrollment applications and conduct required state and federal screenings for Medicaid, CHIP, and other state healthcare programs, then make accurate enrollment recommendations within 10 business days. Research complex cases, communicate findings, support colleagues and leadership, and contribute to special projects, training, policies, and screening systems.
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