Manage the day to day responsibilities of telephone performance, coaching/counseling the customer service team, and inventories of offline work including eCorrespondence, social media, and HIPAA/Privacy form updates. Responsible for systemic testing related to updates to the CRM and the website portal; assist in training initiatives. Drive weekly meetings with call center

Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance. Develop studies, analyses, and presentation materials needed to appropriately inform decision makers. Complete pricing analysis, experience analysis and studies, financial projections, and other actuarial/financial calculations. Run, modify, and create

Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance. Participate in product development, pricing, filing, and rating implementation of new products and strategies. Develop studies, analyses, and presentation materials needed to appropriately inform decision makers. Answer questions of less experienced sta

of Position We are seeking a talented Grievance & Appeals Specialist who will be responsible for responding to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, State, and other regulations. They will process appeals and grievances to facilitate the accurate administration of benefits and clinical

of Job Manage the day to day sales activities of the Direct to Consumer and Individual markets (Medicaid, Child Health Plus, The Essential Plan and QHP) and implement any strategic or tactical plans. Work closely with the Regional Sales Leader, Government Assisted Program (GAP), Enrollment and Customer Service to ensure high levels of service and responsiveness. Responsibi

of Job Responsible for implementing end to end campaign creation, execution, delivery and measurement, primarily leveraging Salesforce Marketing Cloud email/journeys, Adobe Campaign, Adobe Experience Manager (CMS), and Adobe Analytics. Participate in the creation of SFMC campaign journey/workflow design, to execute email campaign activation and delivery. Develop automated

Deliver operations training programs that encompass a blended approach (instructor led modules, self paced activities, flipped classroom, group activities, videos, and eLearning). Responsible for multiple training topics (Products, Guidelines, polices & procedures, Systems utilized by Ops staff, etc.) Responsibilities Facilitate delivery (in person and virtual) of product

of Position Serve as the key operational liaison with Provider Network Management and Finance responsible for the reconciliation, reprocessing/recoupment and provider communication for claim payment integrity challenges. Oversee contract review; ensure that contract provisions are in alignment with corporate goals. Develop and implement dashboards to monitor performance. D

of Position We are seeking a dynamic Grievance and Appeals Dispute Specialist who will be responsible for processing disputes submitted by contracted and non contracted providers. The types of correspondence handled by the individual will include, but is not limited to; correspondence, HQSI/ESMSEF appeals and Cotiviti disputes. This individual will provide technical and ad

of Position We are seeking a dynamic Contract Specialist who will be responsible for loading all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner. This individual will provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement. The Contract

Conceptualize, research, develop, implement, maintain, and enhance Contact Center related training programs/materials. Facilitate training classes to support the Contact Center provide technical, administrative, and other support as needed. Ensure that training covers critical Contact Center areas such as customer service skills; policies and procedures; new hire orientat

of Job Ideate, develop, and deliver formal and informal training for the new hire and current sales employees. Coach and mentor staff to meet sales and retention goals. Collaborate on development of production reports/metrics; analyze production reports and adjust coaching and training as necessary and present the findings to leadership. Responsibilities Lead, develop, and

Serves in an account management (non sales) role as the primary business to business liaison between ConnectiCare and its provider network and is responsible for all interactions between the organizations. Continuously educates provider community about ConnectiCare and its policies and procedures. Build and develop partnerships with ConnectiCare's Tier I and Tier II provi

of Job Identify opportunities to improve efficiency; lead small to mid size projects; assist other project managers on larger, more complex projects related to operational business functions that affect team members and providers at the market level. Utilize critical reporting and data analysis to support broker performance and training. Provide support and issue resolutio

Participates and supports the health team in direct patient care. Performs duties involving direct patient care as assigned by the physician within the framework of the New York State Nurse Practice Act and AdvantageCare Physicians' policies and procedures. Identifies physical, behavioral, and emotional characteristics typical for the age group of the patient receiving ca