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Tulsa, OK, USA ● Req #487Thursday, March 21, 2024JOB 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 an ...Read more about Quality Improvement - Intake Coordinator 195-1012More
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JOB SUMMARY: Responsible for performing health intake functions, directing members to services needed. KEY RESPONSIBILITIES: •Verifies member eligibility, line of business and network affiliations for members and providers. Determines if the call is clinical and requires transfer to a clinical staff person. Will inform callers, including members, facility personnel, physicians, or other health care professionals of the utilization requirements and procedures. •Makes initial referrals that ...Read more about Behavioral Health - Intake Specialist 150-1002More
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JOB SUMMARY: The 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. KEY RESPONSIBILITIES: Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making i ...Read more about Claims HMO - Claims Examiner 140-1025More
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Tulsa, OK, USA ● Req #204Thursday, March 21, 2024JOB 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:D ...Read more about Information Technology - Senior Software Engineer 130-2014More
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Tulsa, OK, USA ● Req #469Tuesday, February 27, 2024JOB SUMMARY: The Managed Care Clinical Pharmacist will provide clinical pharmacy support to the CommunityCare Pharmacy Department including development of criteria for medications requiring a prior authorization, management of the drug utilization protocol, clinical support for the CMS Medication related STARs Measures, Medication Therapy Management (MTM) outreach, and other clinical duties as needed. The ability to influence members and providers to act is important. This position will also wo ...Read more about Pharmacy - Managed Care Clinical Pharmacist 146-2002More
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Tulsa, OK, USA ● Req #468Friday, February 23, 2024JOB SUMMARY: Responsible for the development and implementation of new computer applications in addition to maintaining and executing applications. KEY RESPONSIBILITIES: Design, code and implement applications related to operations and system functions. Maintain and update existing applications, processes and required system functions. Perform special projects. Train end-users as needed. Perform other duties as assigned. QUALIFICATIONS: Ability to assess and prioritize issues an ...Read more about Information Technology - Programmer Analyst 130-2020More
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Tulsa, OK, USA ● Req #470Friday, February 23, 2024JOB 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 t ...Read more about Quality Improvement - Member Engagement Specialist 195-1008More
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Tulsa, OK, USA ● Req #471Friday, February 23, 2024JOB 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 t ...Read more about Quality Improvement - Member Engagement Specialist 195-1017More
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Tulsa, OK, USA ● Req #472Friday, February 23, 2024JOB SUMMARY: Responsible for monitoring and reviewing communication skills displayed by Customer Service Representatives to assure quality customer service skills and member satisfaction. KEY RESPONSIBILITIES: Monitors the Customer Service lines and makes recommendations to improve the effectiveness of the individual representatives. Responsible for supporting performance guarantees by maintaining quality monitor audits, percentages of accuracy, and other data elements as required. Provi ...Read more about Operational Support - Quality Review Specialist 139-1030More
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Tulsa, OK, USA ● Req #473Friday, February 23, 2024JOB SUMMARY: Responsible for all aspects of enrollment and eligibility for all products. Develops and implementsprocedures to improve and minimize human error while increasing output and production. Trains personnel on government regulations, processes, and timelines related to processing eligibility. Keeps abreast of incoming changes in legislation and regulatory issues that impact the products enrollment process. KEY RESPONSIBILITIES: Manages operations of enrollment activities includi ...Read more about Enrollment Services - Supervisor Enrollment 160-4002More
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Tulsa, OK, USA ● Req #448Thursday, February 15, 2024JOB SUMMARY: As a Software Engineering Intern, you will work closely with our experienced development team to design, implement, and maintain software solutions using C# on the Microsoft Azure cloud platform. This role provides a unique chance to contribute to the development of scalable and reliable applications that leverage the power of cloud computing. KEY RESPONSIBILITIES: Software Development: Collaborate with the development team to design and implement software solutions using C# a ...Read more about Information Technology- Software Engineer Seasonal InternMore
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JOB SUMMARY: This non-clinical position supports the department by performing a broad range of clerical duties. KEY RESPONSIBILITIES: Prepares correspondence to members, providers, and facilities. Provides follow up with providers and members as needed. Reviews service requests for completeness of information. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers non-clinical questions and takes information, or refers callers to appropriate ...Read more about Medical Management - Intake Coordinator 145-1013More
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Tulsa, OK, USA ● Req #450Thursday, January 11, 2024JOB SUMMARY: The Senior Financial Analyst will embrace a strong emphasis on financial modeling and management reporting. As a key member of our finance team, they will be responsible for developing, analyzing, and presenting financial models and reports that drive strategic decision-making across the organization. In addition, the Senior Financial Analyst will be responsible for extracting insights from complex financial data, developing sophisticated financial models, and providing strategic re ...Read more about Financial Planning & Analysis - Senior Financial Analyst 127-2006More
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Tulsa, OK, USA ● Req #433Thursday, January 4, 2024JOB SUMMARY: The IT Project Management Intern will play a crucial role in supporting our Health Plan's projects by assisting in the implementation and optimization of project management tools and methodologies, with a specific emphasis on agile practices. This internship offers a unique opportunity to gain hands-on experience in healthcare IT project management while contributing to the success of impactful initiatives. KEY RESPONSIBILITIES: Tools Implementation and Optimization: Assist in t ...Read more about Information Technology- Project Manager Seasonal InternMore
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Tulsa, OK, USA ● Req #434Thursday, January 4, 2024JOB SUMMARY: The Data Engineering Intern will work closely with our experienced data engineering team to support the development, implementation, and optimization of data pipelines and systems. This role will contribute to the organization's ability to derive meaningful insights from healthcare data, ultimately improving the quality of care and services provided to our members. KEY RESPONSIBILITIES: Data Pipeline Development: Collaborate with the data engineering team to design, develop, and ...Read more about Information Technology- Data Engineer Seasonal InternMore
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Tulsa, OK, USA ● Req #421Thursday, December 14, 2023JOB SUMMARY:Responsible for understanding application functionality, documenting test cases based on requirements and acceptance criteria, and assisting in automating tests for those test cases. Able to collaborate with business, project, and development stakeholders to understand new and existing features and functionality. Document test results for automated and manual tests. The Quality Assurance Specialist is responsible for the development of automated testing methods for existing and new ...Read more about Information Technology - QA Specialist 130-2055More
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Tulsa, OK, USA ● Req #430Thursday, December 14, 2023JOB 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. The ideal Customer Service Representative will b ...Read more about Customer Service - Customer Service Representative 105-1016More
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Tulsa, OK, USA ● Req #355Thursday, August 17, 2023JOB SUMMARY: Directs the Data Analytics and Reporting, Actuarial, and Underwriting activities of the Company, including product and bid filing activities. Directs the development and analysis of the financial budget, with particular emphasis on premiums, medical costs and provider reimbursement plans. Directs and manages the analysis of medical, pharmacy, and other claim costs and related expenses, including utilization and other trends affecting the company. Directs and manages the estimation ...Read more about Accounting/Finance - Director Actuarial & AnalyticsMore