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The Quality Assurance Auditor conducts internal quality assurance audits of operational processes, investigates appeals and grievances, and analyzes errors. They provide feedback for improvement and document findings, all while working remotely and supporting departmental policies and procedures.
The Sr Manager of Data Products will lead a team to create a sophisticated data platform and solutions. Responsibilities include defining the vision and objectives, managing the product backlog, coordinating with stakeholders, and ensuring best practices for performance and compliance are followed.
The Support Coordinator assists care/case managers with non-clinical tasks including creating cases, providing telephonic outreach, handling member mailings, and faxing clinical requests. They are part of a dedicated clinical team and may have additional responsibilities.
The Bilingual Retention Coordinator (Spanish) provides telephonic support to members and families regarding financial entitlements related to Medicare and Medicaid. Responsibilities include managing inbound and outbound calls, educating clients on programs, scheduling appointments, and documenting interactions in Salesforce while complying with regulations and maintaining confidentiality.
The Community Engagement Specialist will connect communities to health resources, manage relationships with community partners, track and evaluate engagement efforts, and organize community events to promote well-being and health equity.
The Senior Manager for the Migration team oversees migration initiatives, leading a team of technical professionals and managing project timelines. Responsibilities include developing strategies, ensuring technical requirements are met, troubleshooting issues, and providing updates on Agile deliverables while conducting post-migration reviews for improvements.
The Performance Support Specialist assists in resolving customer complaints, maintaining complaint tracking systems, and reaching out to members. They provide support to internal and external business partners, make recommendations for process improvements, and manage inquiries from various departments. This role requires excellent customer service skills and the ability to multitask efficiently.
The Principal Cloud Database Engineer designs, implements, and manages cloud-based database solutions, ensuring high performance, data integrity, and security. Responsibilities include database administration, performance tuning, automation, and collaboration with development and infrastructure teams. This role also involves capacity planning, monitoring, and compliance with data protection regulations while leading technical initiatives and supporting operational excellence.
The Sr Operations Coding Analyst is responsible for making complex coding decisions on claims and appeals, guiding junior analysts, and ensuring compliance with coding guidelines and policies. They lead improvements in claims editing processes, monitor performance, and resolve provider disputes, utilizing independent judgement and collaboration with other departments and vendors.
The Support Coordinator assists care/case managers with non-clinical tasks, provides telephonic outreach to members and providers, manages case documentation, and handles member inquiries and authorizations. They communicate issues and monitor screenings to ensure effective intervention and may have additional departmental responsibilities.
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