Top Tech Jobs & Startup Jobs

The Appeals Specialist performs non-medical reviews, processes redetermination letters, and collaborates with departments to ensure accurate determinations for members.

The Administrator of Contract Oversight prepares and generates contractual agreements, conducts reviews, negotiates terms, resolves issues, and coordinates with legal counsel to ensure compliance with business requirements.

Responsible for accurate processing of claims, verifying coding, resolving errors, and coordinating with internal departments for updates and edits.

Design and maintain network infrastructure while ensuring effective use of technology. Optimize performance, evaluate new products, and lead technical support teams.

Lead accreditation compliance activities, monitor adherence to NCQA standards, conduct audits, analyze results, and implement corrective actions to ensure quality care and compliance.

This role develops training materials, provides training, evaluates employee performance, and manages training programs for various audiences.

The Associate will manage logs, provide customer service via phone, complete EDI requests, and support audits. Ensures accuracy in processing electronic transactions and assists the team with various functions.