• Health Services Program Manager, UCLA Health…

    UCLA Health (Los Angeles, CA)
    …preferred * 3-5 years of experience in healthcare program management, ideally within a Medicare Advantage plan or health insurance setting, preferred * ... role in driving the success of key initiatives for the UCLA Health Medicare Advantage Health Plan. In this role, you will: * Oversee the planning, execution,… more
    UCLA Health (01/19/25)
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  • Claims processing - Medical Insurance

    Trinity Health (Columbus, OH)
    …auditing, billing and/or coding. **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and ... billing and/or coding. + Must possess an in-depth knowledge of current Medicare coding and billing requirements + Advanced knowledge of current medical terminology,… more
    Trinity Health (01/17/25)
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  • Internal Sales Specialist

    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
    Baylor Scott & White Health (01/09/25)
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  • Provider Relations Network Manager

    Trinity Health (Columbus, OH)
    …be able to work remotely. **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other ... and quality + Working knowledge of protocols and procedures of Centers For Medicare and Medicaid Services + Proven ability to work effectively with internal and… more
    Trinity Health (12/19/24)
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  • Operations Resolution Specialist - Provider Data…

    Trinity Health (Columbus, OH)
    …time **Shift:** **Description:** **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and ... CPC, CPC-P or equivalent required. Member Services department: Active State of Ohio Insurance License (Life and Health) or obtained within 90 days of hire. Risk… more
    Trinity Health (12/19/24)
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  • VP, Medicare Advantage (Remote…

    Molina Healthcare (Columbus, OH)
    **Job Summary** As the leader for Molina's Medicare Advantage product (Non-Dual), this position has P&L, business strategy, sales distribution and provider ... with senior leadership, determines the annual implementation of Molina's Medicare Advantage product strategic plan. + Has...The ideal candidate will have deep experience in the Insurance industry, with a proven track record of hitting… more
    Molina Healthcare (01/21/25)
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  • Medicare Advantage Quality…

    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
    Highmark Health (11/14/24)
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  • Medicare Advantage Provider…

    The Cigna Group (Bloomfield, CT)
    …for the right candidate.** Ability to travel up to 25%.** **OVERVIEW:** The Medicare Advantage (MA) Provider Operations Senior Director is a senior leadership ... provider data and configuration changes for our regulated business ( Medicare Advantage , , etc.), to work with...also offer 401(k) with company match, company paid life insurance , tuition reimbursement, a minimum of 18 days of… more
    The Cigna Group (01/23/25)
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  • Medicare Advantage Product Solutions…

    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
    LA Care Health Plan (10/30/24)
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  • Sr Actuarial Analyst - Medicare

    BlueCross BlueShield of North Carolina (NC)
    **Job Description** Are you an experienced actuarial professional with a passion for Medicare Advantage ? Join our dynamic team as a Senior Actuarial Analyst, ... premiums, risk scores, and reserves for new and existing insurance plans. + Support senior analysts and actuaries as...required). + Minimum of 4 years of experience in Medicare Advantage . + Completion of at least… more
    BlueCross BlueShield of North Carolina (01/07/25)
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  • Medicare Advantage Delegation…

    Providence (Beaverton, OR)
    …we know that to inspire and retain the best people, we must empower them.** ** Medicare Advantage is a strategic growth strategy for PH&S and Providence Health ... emerging markets. It will be managing and leading various enterprise-wide Medicare compliance-related initiatives and projects in relation to our delegated entities.… more
    Providence (01/22/25)
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  • Utilization Management Reviewer - Medicare

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …RoleThe Clinical Utilization Reviewer is responsible for facilitating care for our Medicare Advantage members who may have complex healthcare needs, authorizing ... and escalate quality of care issues. + Understand member insurance products and benefits, as well as regulatory and...care). + Utilization Management experience, preferred + Experience with Medicare Advantage , preferred + Active licensure in… more
    Blue Cross Blue Shield of Massachusetts (12/19/24)
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  • Medical Sales

    Adecco US, Inc. (Bradenton, FL)
    …for this opportunity, you must have the following: + Experience with selling Medicare Advantage /sold insurance , healthcare sales (that involved seniors), ... and/or community experience that also includes sales. + Easily able to overcome objections in the field such as why someone should switch their current medical provider. + HS Diploma or GED required; Bachelor's degree is helpful **Job Description:** + Promotes… more
    Adecco US, Inc. (01/10/25)
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  • Insurance Segment Strategy Lead

    Humana (Columbus, OH)
    …Medicaid, Med Supp, PDP, and others), with an emphasis on Medicare Advantage strategy development. As an Insurance Segment Strategy Lead, 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
    Humana (11/13/24)
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  • Medicare Sales Operations Specialist - Sr.

    Medical Mutual of Ohio (OH)
    …with government health insurance programs which includes exposure to Medicare Advantage , MA compliance protocols, member experience, agent experience, case ... self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and...health insurance programs which includes exposure to Medicare Advantage , MA compliance protocols, member experience,… more
    Medical Mutual of Ohio (12/12/24)
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  • Senior Actuarial Analyst, Medicare Bid…

    Providence (OR)
    …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
    Providence (12/16/24)
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  • Billing Follow Up Medicare

    Chesapeake Regional Healthcare (Chesapeake, VA)
    …for the compliant, accurate and timely billing and follow-up of all hospital Medicare and Medicare Advantage Patient Accounts. Essential Duties and ... limited as other tasks may be assigned. + Submit Medicare / Medicare Advantage plan claims both...lacl aims resolution is achieved + Generates letters to insurance or patients as needed in order to resolve… more
    Chesapeake Regional Healthcare (12/05/24)
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  • Associate General Counsel ( Medicare )

    Centene Corporation (Jefferson City, MO)
    …advising management concerning state and federal legislation with a focus on Medicare Advantage and Prescription Drug plans, regulations and other requirements ... law, health law and managed care preferred Knowledge of Medicare and/or Medicaid insurance , state insurance...in good standing preferred **Preferred Criteria:** Inhouse experience with Medicare Advantage and Prescription Drug Plans and… more
    Centene Corporation (01/10/25)
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  • Medicare Specialist (HHS)

    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
    Walworth County (01/11/25)
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  • Licensed Practical Nurse/Licensed Vocational Nurse…

    STG International (Milledgeville, GA)
    …+ Coordinate Pre-certification sand recertification in accordance with facility policies for Medicare Advantage and + commercial insurance payers. + ... Interpret the department's policies and procedures to personnel, residents, visitors and government agencies as required. + Participate in developing, maintaining, and updating written facility policies and procedures that govern the day-to-day functions of… more
    STG International (01/18/25)
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