- Humana (Columbus, OH)
- …experience in a medical management review organization, such as Medicare Advantage , managed Medicaid, or Commercial health insurance . + Experience with ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Baylor Scott & White Health (Columbus, OH)
- …plan design. **KEY SUCCESS FACTORS** Sales experience in HMO or PPO individual health insurance , Medicare Advantage insurance , group health insurance ... FUNCTIONS OF THE ROLE** Coordinates and conducts sales activities for Individual and Medicare Advantage plans to enroll prospective members into the health plan… more
- Highmark Health (Harrisburg, PA)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… more
- LA Care Health Plan (Los Angeles, CA)
- Medicare Advantage Product Solutions Manager II Job Category: Administrative, HR, Business Professionals Department: Medicare Product Location: Los Angeles, ... strategic planning on product agnostic initiatives as well as strategic partnerships. Medicare : Required Medicare Advantage , with experience serving duals… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Senior Contact Center Representative, you will be addressing and resolving complex member inquiries, providing detailed ... working in a Contact Center environment + Two or more years in a Medicare Advantage role, highly desired + Exceptional customer service and communication skills… more
- UCLA Health (Los Angeles, CA)
- …level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM ... coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and...Ability to analyze and organize complex federal and private insurance regulations + Ability to travel/attend off-site meetings and… more
- The Cigna Group (Plano, TX)
- …will be accountable for the financial results and medical cost savings of Medicare Advantage payment integrity programs. Work with business partners to identify ... driving medical cost and affordability saving strategies + Knowledge of various Medicare reimbursement methodologies such as MS-DRG, OPPS, IPPS, APR-DRG, and Fee… more
- CareFirst (Washington, DC)
- …The incumbent will have primary responsibility for issues related to Medicare / Medicare Advantage , prescription drugs, utilization management, and ... operational processes and impacts of regulatory guidance + Understanding of insurance products and regulatory environment + Proven analytical and problem-solving… more
- Providence (OR)
- …empower them._** **Providence Health Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + Perform internal coding audits ... Plan with employer matching, health care benefits (medical, dental, vision), life insurance , disability insurance , time off benefits (paid parental leave,… more
- The Cigna Group (Bloomfield, CT)
- …relevant experience in progressively responsible leadership roles focused on managed Medicare and provider engagement. + **Experience from a large, complex managed ... or provider system with at least (5) five years of innovative Medicare risk, value-based, and/or fee-for-service contracting experience required** + Strong financial… more
- The Cigna Group (Denver, CO)
- …reporting and analysis within the Clinical & Data Science Analytics team for Medicare Strategic Analytics. Reporting to the Manager of Care Management Analytics, the ... partners to improve customer care and affordability for Cigna Medicare . This role will help us accomplish this through...also offer 401(k) with company match, company paid life insurance , tuition reimbursement, a minimum of 18 days of… more
- ManpowerGroup (Meridian, ID)
- …receiving/making calls, previous experience in contact/call center, customer service, health insurance , Medicare Advantage , and/or medical office, phenomenal ... script + Previous experience in contact/call center, customer service, health insurance , Medicare Advantage , and/or medical office will help support your… more
- Elevance Health (Santa Ana, CA)
- …the end of each day. + Requests prior-authorizations for PCP and Specialty Gastroenterology from Medicare HMO Advantage Insurance Groups as well as Fee For ... Experience working with Electronic Medical Records (EMR) preferred. + Knowledge of insurance eligibility. + Experience in specialty areas. For candidates working in… more
- Humana (Columbus, OH)
- …highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Insurance Strategy Consultant, you will ... performance of strategic initiatives and business areas, evolving key facets of the Medicare Advantage growth strategy, leading the development of the annual … more
- Medical Mutual of Ohio (Brooklyn, OH)
- …offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. The ... is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of...Medicare Advantage Products Analyst plays an integral role in the… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Implements and ... is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of...manages the implementation and daily operation of the Medicare Advantage Compliance Program and all compliance-related… more
- Providence (WA)
- …data, and providing strategic insights to support the pricing and bidding process for our Medicare Advantage plans + Have a deep understanding of Medicare ... guidelines, and providing critical insights to enhance the performance of our Medicare Advantage plans **_Please note the following important detail regarding… more
- Humana (Columbus, OH)
- …Senior Products Actuarial Compliance team focused on special Medicare Advantage programs, including Value Based Insurance Design (VBID), Special Supplemental ... and allows you to see the overall end to end bid process at a leading Medicare Advantage organization. This is a great role for a collaborative individual who is… more
- Walworth County (Elkhorn, WI)
- …Medicare beneficiaries with enrollment issues regarding Medicare Part D, Medicare Part C ( Advantage Plans) and SeniorCare by providing one-on-one ... Medicare Specialist (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/3201106) Apply Medicare Specialist (HHS) Salary $18.70 Hourly… more
- CommuniCare Health Services Corporate (Indianapolis, IN)
- …submission per Medicare , Commercial, and Medicaid billing guidelines + Submission of Medicare Advantage Copy claims + As Medicare payment occurs, ... Medicare & Secondary Billing Guidelines + Previous experience billing various Medicare and Co- insurance companies and understanding the requirements for each… more