Resp & Qualifications PURPOSE… The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and regulations that govern the appeal process for Commercial and Government Programs lines of … Read more
Resp & Qualifications Purpose… The Underwriting Consultant underwrites more complex new policies and modifications to existing group contracts. Frequently interacts with agents/applicants on problem cases. Performs case quality audits and training of less seasoned Underwriters’ work. Essential Functions: • Applies underwriting policies and procedures to complex situations and/or large groups to evaluate risks. Monitors trends … Read more
Resp & Qualifications PURPOSE… Manages and guides a team of technical writers and web developers responsible for managing the content within software applications. Delivers technical content about products and services. ESSENTIAL FUNCTIONS: • Develop and manage user assistance content that customers value and trust by leveraging industry best practices and tool sets, and by integrating … Read more
Resp & Qualifications PURPOSE… The Administrator will be responsible for leading procurement systems administration and implementation of strategic processes. This critical role will assist in defining the best practices for purchasing goods and services that are requested by all departments across the organization, ensure audit controls are followed for PO processing, assist with training on … Read more
Resp & Qualifications PURPOSE… The Lead Contract Specialist will play a pivotal role in taking charge of the processes including facilitating meetings with various levels of leadership and education and implementation on service level requirements (SLRs), which are a key cornerstone of the work performed within the organization. Under the direction of the leadership this … Read more
Resp & Qualifications PURPOSE: The Vendor Relations Specialist is responsible for corporate vendor and supplier management assigned to Payment Integrity department, and focuses on developing and managing business partnerships. This role provides support for business operational needs identifying opportunities for improvement that align with the enterprise vendor engagement strategy. serves as a… strategic advisor to … Read more
Resp & Qualifications PURPOSE… The Payment Integrity Analyst is responsible for conducting research and analysis and reviewing billing requirements, provider manuals, medical policies, and other sources as needed to identify new overpayment concepts, as well as, validate all prospective and retrospective overpayment results; communicating findings to the Payment Integrity Workgroup and Management. The incumbent will … Read more