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  • ● Req #59
    Tuesday, August 9, 2022
    JOB SUMMARY:This position supports the department by performing a broad range of clerical duties. KEY RESPONSIBILITIES:Prepares correspondence to members and provider facilities. Follow up with providers and members as needed. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers question and takes information, or refers callers to appropriate parties. Investigates and researches complaints from members, physician offices, ancillary vendors, and ... More
  • ● Req #60
    Tuesday, August 9, 2022
    JOB SUMMARY:  The Senior Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency. The Senior Claims Examiner will generally handle claims involving multiple lines of business or has been permanently assigned additional respons ... More
  • ● Req #55
    Friday, August 5, 2022
    JOB SUMMARY: This role serves as the executive leader of the Medicaid line of business and will be responsible for the overall strategic direction, infrastructure development, operations, and management team, administering the plan in line with the organization’s mission and strategic imperatives. This role will be fully accountable for all organizational functions and will report directly to the President & CEO of CommunityCare with guidance from CommunityCare Executives and the Board of Direct ... More
  • ● Req #51
    Wednesday, August 3, 2022
    JOB SUMMARY:Responsible for servicing the health plan needs of members and providing information and education on policies, procedures, benefits and services to members. Coordinates the Health Assessment Program to ensure Medicare requirement are met and policy is followed. KEY RESPONSIBILITIES: Responsible for entering HAP assessments into the HAP database, coordinates distribution/mailing of reports, follow up letters and educational materials for all Medicare lines of business. Compile quarte ... More
  • ● Req #52
    Wednesday, August 3, 2022
    JOB SUMMARY:  Responsible for completing out-bound calls and other member outreach opportunities to select members and documenting efforts. This role spends 100% of time on quality program activities. May require extended, or multiple, phone calls to members. May require work on additional projects as directed. KEY RESPONSIBILITIES: Contact members selected for intervention. Assist members with developing a plan to resolve identified HEDIS gaps in care, setting up appointments, getting to and fr ... More
  • ● Req #50
    Friday, July 29, 2022
    JOB SUMMARY:  The Delphi Engineer will build out the next generation of our platform. As a Delphi Engineer, you are expected to work independently, and within teams, leading the development of software features. Ability to prioritize well, communicate clearly, have a consistent track record of delivery, and excellent software engineering skills. You will be involved with mentoring other team members and helping with identifying process improvements for the team.   KEY RESPONSIBILITIES: Dev ... More
  • JOB SUMMARY:  Responsible for all written inquiries from members seeking resolution through the grievance and appeals process. KEY RESPONSIBILITIES: Researches member issues and prepares grievance and appeals information for each level of the appeal process. Responsible for adhering to established grievance and appeals timeframes. Assures compliance with Federal, State and Accreditation regulations.Receives and responds to member and/or provider written and oral complaints and requests in accord ... More
  • ● Req #47
    Thursday, July 28, 2022
    JOB SUMMARY:  The Senior Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency. The Senior Claims Examiner will generally handle claims involving multiple lines of business or has been permanently assigned additional respons ... More
  • JOB SUMMARY:The Sr. Manager, Financial Reporting will create and distribute all internal and external financial reporting documents, as well as manage and coordinate all independent financial statement audits. The Manager must be an effective manager and empathetic leader and demonstrate an ability to engage their team. KEY RESPONSIBILITIES: The Manager must be aware of reporting deadlines and appropriately manage the department activities to meet all reporting deadlines and adhere to regulatory ... More
  • ● Req #44
    Wednesday, July 27, 2022
    JOB SUMMARY: Responsible for maintaining and supporting the Help Desk and new systems including network installations, personal computers support and maintenance, and infrastructure development. Focus on increasing customer utilization of existing operations and systems. Overseeing the Help Desk to ensure that high service levels are maintained while effectively managing customer expectations.   KEY RESPONSIBILITIES: Assist with building a cohesive team and to lead ... More
  • ● Req #43
    Wednesday, July 27, 2022
    JOB SUMMARY: Responsible for marketing the company’s commercial products to prospective clients and for assisting in the servicing and retaining existing accounts.   KEY RESPONSIBILITIES: Identifies and sells lines of business directly to potential corporate clients and through an assigned distribution of agents/brokers. Group market includes an emphasis on small and large group market. Must comply with provisions contained within the Sales Compensation Program.  Identi ... More
  • ● Req #41
    Wednesday, July 27, 2022
    JOB SUMMARY:This position is responsible for supporting the grievance and appeals activities pertaining to all written inquiries from members and providers requesting resolution through the grievance and appeals process. This includes claims and authorization research. Duties are varied and including typing, filing, photocopying, telephone follow-up, data entry, and preparation of information for presentation at committee meetings. KEY RESPONSIBILITIES: Initiate research for grievance and appeal ... More
  • ● Req #40
    Wednesday, July 27, 2022
    JOB SUMMARY: The Analyst provides analytical support for the Finance department. This support will involve preparing reports and analyzing data using the company’s database or applicable software. Duties involve running routine reports, modifying existing reports, writing new reports and analyzing data. The analyst also answers questions and provides clarification regarding data and analysis to management and outside entities.  KEY RESPONSIBILITIES: Prepares and assists in the creation of variou ... More
  • JOB SUMMARY: The Manager of the Financial Planning & Analysis Team is responsible for coordinating the assigned workflow for the team members, training, brainstorming and test new assignments, audit existing code, and reports produced by team members. In addition, the manager develops the corporate budget for premium and medical expense, upload data for the Accounting Department for the General and Administrative budget, prepare budget variance explanations and respond to management for work pro ... More
  • ● Req #38
    Wednesday, July 27, 2022
    JOB SUMMARY:The Sr. Software Engineer will build out the next generation of our platform. As a Sr. Software Engineer, you are expected to work independently, and within teams, leading the development of software features. Ability to prioritize well, communicate clearly, have a consistent track record of delivery, and excellent software engineering skills. You will be involved with mentoring other team members and helping with identifying process improvements for the team.KEY RESPONSIBILITIES: De ... More
  • ● Req #37
    Wednesday, July 27, 2022
    JOB SUMMARY:The Sr. Software Engineer will build out the next generation of our platform. As a Sr. Software Engineer, you are expected to work independently, and within teams, leading the development of software features. Ability to prioritize well, communicate clearly, have a consistent track record of delivery, and excellent software engineering skills. You will be involved with mentoring other team members and helping with identifying process improvements for the team.KEY RESPONSIBILITIES:Dev ... More
  • ● Req #36
    Wednesday, July 27, 2022
    JOB SUMMARY: Responsible for working with members, providers, and other multidisciplinary team members to facilitate, collaborate and coordinate healthcare for members identified with complex healthcare needs. Work with members throughout the continuum of care to enhance the members healthcare experience and assist with the provision of cost-effective healthcare options. KEY RESPONSIBILITIES: Complete clinical assessments of members requiring case management oversite to assist with facilitation ... More
  • ● Req #35
    Wednesday, July 27, 2022
    JOB SUMMARY:This position supports the department by performing a broad range of clerical duties. KEY RESPONSIBILITIES:Prepares correspondence to members and provider facilities. Follow up with providers and members as needed. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers question and takes information, or refers callers to appropriate parties. Investigates and researches complaints from members, physician offices, ancillary vendors, and ... More
  • ● Req #34
    Wednesday, July 27, 2022
    JOB SUMMARY: Responsible for clinical review of services requiring medical authorization and documentation of decisions and clinical information. This role practices independent judgement using clinical knowledge prioritizing cases based upon medical necessity and regulatory guidelines. In addition, uses discretion with everyday confidentiality preserving patient cases.  KEY RESPONSIBILITIES: Reviews requests for services (inpatient, ancillary, and outpatient). Makes decisions according to guide ... More
  • ● Req #33
    Wednesday, July 27, 2022
    JOB SUMMARY: Responsible for working with members, providers, and other multidisciplinary team members to facilitate, collaborate and coordinate healthcare for members identified with complex healthcare needs. Work with members throughout the continuum of care to enhance the members healthcare experience and assist with the provision of cost-effective healthcare options. KEY RESPONSIBILITIES: Complete clinical assessments of members requiring case management oversite to assist with facilitation ... More
  • ● Req #32
    Wednesday, July 27, 2022
    JOB SUMMARY: Responsible for working with members, providers, and other multidisciplinary team members to facilitate, collaborate and coordinate healthcare for members identified with complex healthcare needs. Work with members throughout the continuum of care to enhance the members healthcare experience and assist with the provision of cost-effective healthcare options. KEY RESPONSIBILITIES: Complete clinical assessments of members requiring case management oversite to assist with facilitation ... More
  • ● Req #42
    Wednesday, July 27, 2022
    JOB SUMMARY:  Responsible for clinical review of services requiring medical authorization and documentation of decisions and clinical information. Communicate decisions and process to providers as indicated. Serves as a resource to other internal departments. Provide direction and support to Patient Care Coordinator activities and serves as a resource to the department staff in resolving associated problems and issues that arise.  KEY RESPONSIBILITIES: Review requests for services (inpatient, an ... More
  • ● Req #31
    Wednesday, July 27, 2022
    JOB SUMMARY:  Responsible for clinical review of services requiring medical authorization and documentation of decisions and clinical information. This role practices independent judgement using clinical knowledge prioritizing cases based upon medical necessity and regulatory guidelines. In addition, uses discretion with everyday confidentiality preserving patient cases.  KEY RESPONSIBILITIES: Reviews requests for services (inpatient, ancillary, and outpatient). Makes decisions according to guid ... More
  • ● Req #30
    Wednesday, July 27, 2022
    JOB SUMMARY: Responsible for auditing and testing company processes and controls for compliance with regulatory requirements and company policies. Meet with process owners to discuss instances of non-compliance and request corrective action plans, where necessary. Prepare audit reports and present to the Internal Audit Committee. Track and monitor corrective action plans through implementation. Validate identified issues to ensure that corrective actions have addressed the root cause and are pre ... More
  • JOB SUMMARY:Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers.You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions.You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction.Handle calls from multiple lines of business, assist i ... More