• Medical Director - National Medicare Team

    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
    Humana (11/08/24)
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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 (10/01/24)
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  • Medicare Advantage Customer…

    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. Facilitates and ... has the option to work remote; Ohio residents preferred._** **Responsibilities** ** Medicare Advantage Customer Experience Strategist** + **Facilitates projects… more
    Medical Mutual of Ohio (11/15/24)
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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 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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  • Medicare Advantage - Senior Contact…

    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 ... required + Two or more years working contact center environment or experience with Medicare Advantage health plan, highly desired + Working knowledge of … more
    UCLA Health (11/15/24)
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  • Utilization Management Manager, Medicare

    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
    UCLA Health (08/23/24)
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  • Business Analytics Advisor ( Medicare

    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
    The Cigna Group (11/12/24)
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  • Senior Public Policy Analyst - Medicare

    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
    CareFirst (10/01/24)
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  • Business Analytics Lead Analyst ( Medicare

    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
    The Cigna Group (10/25/24)
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  • Business Analytics Advisor ( Medicare

    The Cigna Group (Nashville, TN)
    **Summary** The Cigna Medicare Strategic Analytics Team (MSAT) offers solutions which provide actionable insights to internal and external business partners and ... behavioral health programs. We also offer 401(k) with company match, company paid life insurance , tuition reimbursement, a minimum of 18 days of paid time off per… more
    The Cigna Group (11/19/24)
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  • Medical Assistant I - La Mirada

    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
    Elevance Health (10/27/24)
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  • Insurance Strategy Consultant

    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
    Humana (11/05/24)
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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 Products Analyst

    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 (11/12/24)
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  • Actuary, Risk and Compliance

    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
    Humana (10/29/24)
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  • Senior Actuarial Analyst, Medicare Bid…

    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
    Providence (10/31/24)
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  • Medicare Clinical Auditor

    Medical Mutual of Ohio (OH)
    …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Working under ... is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
    Medical Mutual of Ohio (11/15/24)
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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 (10/12/24)
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  • Medicare Biller / Accounts Receivable

    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
    CommuniCare Health Services Corporate (11/13/24)
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