Manage multiple channel interactions with excellent communication skills.
Effectively present and discuss products and services to providers.
Establish and maintain positive relationships with providers.
Capital BlueCross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity employer committed to a culture of diversity and inclusion.
Provide advanced analytical, reporting, and problem‑resolution support across various departments.
Partner with operational, technical, clinical, and compliance teams to analyze trends and optimize processes.
Leverage technical acumen, including FACETS and reporting tools, to drive improvements and ensure compliance.
Capital Blue Cross is committed to providing exceptional service to their team and the community. They foster a flexible work environment where health and well-being are prioritized, valuing professional and personal growth through investment in training and continuing education.
Develop and analyze workflows for new client launches and existing program optimization.
Ensure business rules reflect customer’s needs and align with system functionality.
Communicate with customers and internal stakeholders.
CareTria helps clients with healthcare and pharmacy benefits. They value your passion and actions, seeking contributors to their team focused on client satisfaction.
Provide subject matter expertise support on Judi’s function and reporting capabilities related to prior authorization
Take accountability for accurate translation of reporting requirements for Capital Rx’s customers
Support analytics and reporting needs for the prior authorization team and related groups
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They have full-service health benefit management solutions to employers, TPAs, and health plans, with the industry’s leading proprietary Enterprise Health Platform.
Handle customer requests and feedback via phone and email through Salesforce (including troubleshooting and real time assistance).
Be a highly organized go-getter and problem-solver who seeks to enhance our customer experience by delivering accurate, quick and professional assistance.
Answer incoming customer calls, tickets and chats regarding product problems, service questions and general client concerns
Keeper Security is transforming cybersecurity for people and organizations globally. They are trusted by millions of individuals and thousands of organizations, and is the leader for password, passkey and secrets management, privileged access, secure remote access and encrypted messaging.
Responds to telephone inquiries promptly, professionally, and efficiently to provide resolution.
Analyzes provider questions to determine best use of resources to resolve the situation.
Empower AI provides federal agency leaders with tools to elevate their workforce's potential for transformation. They leverage three decades of experience solving complex challenges in Health, Defense, and Civilian missions and are headquartered in Reston, VA.
Independently manage ongoing projects, contributing to work assigned and moving the project forward through the project plan, managing client deliverables.
Prepare documents and reports to support Vendor Procurement project activity, assisting in the development of project strategies and assessing project risks.
Organize and attend stakeholder meetings, documenting action items and decisions, preparing presentation materials, and providing administrative support as needed.
EPIC Insurance Brokers & Consultants is a fast-growing firm in the insurance industry. They have over 3,000 employees nationwide and are headquartered in San Francisco. Their core values are: Owner mindset, Inspire trust, Think big, and Drive results.
Provides analytical support to various business areas and customers.
Acts as subject matter expert providing technical and/or business knowledge to support decision-making processes.
Gathers and interprets customer requirements, competitive information, and industry standards.
Capital Blue Cross is committed to the health and well-being of its members and communities. They are considered one of the “Best Places to Work in PA” and foster a flexible environment where employees are encouraged to prioritize their health and well-being.
Responsible for all aspects of pharmacy analytics needed to support business operations and organizational projects.
Able to partner with customers on analytics tools and visualization to solve problems or answer questions.
Develops and maintains data sets for routine use over time and integrates data for analysis.
Vanderbilt University Medical Center (VUMC) is a global crossroads of teaching, discovery, and patient care located in Nashville, Tennessee. VUMC is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated.
Responsible for planning and executing quality and oversight activities to ensure operational compliance.
Responsible for internal and external case audits for Capital and our delegated UM vendors.
Responsible for educating staff on findings, and the audit tool ensuring a consistent approach.
Capital Blue Cross promises to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
Assist with healthcare operations projects, including workflow analysis and process improvement.
Support corporate compliance and regulatory documentation.
Apply healthcare policies, industry trends, and best practices.
UnityPoint Health is recognized as a Top 150 Place to Work in Healthcare. They champion a culture of belonging where everyone feels valued and respected, honoring the ways people are unique and embracing what brings us together.
Perform in-depth quality audits on customer support calls and email cases.
Ensure accuracy of information and professionalism in customer interactions.
Propose documentation updates to enhance the Customer Service Representative (CSR) experience.
Evry Health aims to bring humanity to health insurance with high-technology health plans that expand benefits, increase access and transparency, and feature a personalized, human approach. They are the major medical division of Globe Life (NYSE:GL), which has 16.8 million policies in force, more than 3,000 corporate employees and 15,000 agents.
Facilitating the analysis and research of EOB’s to problem solve outstanding accounts.
Analyze credit balances and issues refunds as necessary.
CommonSpirit Health is a healthcare organization with over 700 care sites across the U.S., offering services from clinics and hospitals to home-based and virtual care. They are committed to building healthy communities and advocating for those who are poor and vulnerable.
Performs research, analysis, and resolution of moderate to complex deductible and loss-billing issues.
Partners across Claims, Underwriting, Finance, IT, Helmsman and external stakeholders to drive accurate billing outcomes.
Provides guidance to less-experienced analysts and escalates larger operational issues to management.
Liberty Mutual is an insurance company. They value hard work, integrity and commitment to make things better, and they put people first by offering benefits that support life and well-being.
Answer inbound calls and return voicemails from members, delivering exemplary customer service and support.
Troubleshoot and resolve prescription-related issues for members whose plans utilize CVS or Carelon as the PBM.
Coordinate with providers’ offices and retail/mail-order pharmacies as needed to resolve claims processing, prior authorization, and medication access issues.
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. They focus on cost containment strategies and driving down the cost of plans with innovative solutions. Point C provides equal opportunity in all employment practices.
Review, identify and analyze root cause for all escalated service requests; continuously improve based on analysis within delivery teams.
Focus on developing proactive solutions to avoid common issues within escalation process.
Own escalated cases received from various channels including: complaint review requests received from the customer, live HAC escalations, and negative NPS survey responses.
Transcarent is a health and care company bringing medical, pharmacy, and point solutions together. They empower health consumers with choice and higher-quality care and lower costs for 21 million members across more than 1,700 employers and health plans.
Maintain regulatory compliance and prevent losses to members and credit union.
Perform primary telephone support and assist members and employees through all support channels.
Solve practical problems and deal with a variety of situations exercising flexibility and sound judgment.
STCU is a top-performing credit union that emphasizes serving others and lifelong learning. They value employees who are committed, fun-loving, and want to make a difference in members’ lives, with core values including joyfulness, generosity, and belonging.
Provide troubleshooting and resolution for software, product, and technical issues.
Communicate clearly and professionally with clients through phone, email, and other support channels.
Facilitate knowledge articles to support client self‑service and internal team learning.
Experian is a global company in data services, helping organizations and consumers manage risk and make informed decisions. With over 125 years of experience and 21,700 employees across 30 countries, they specialize in data gathering, analysis, and fraud prevention. Experian prioritizes inclusive culture, employee well-being, and career development.
Responsible for ensuring that the Value Hub adheres to regulatory standards, contract requirements, and internal quality benchmarks.
Analyzing compliance data, preparing detailed reports, and working closely with various departments to maintain and improve compliance and quality standards.
Supporting the understanding of local regulatory requirements, completion of local audits, participation in quality committees, and supporting health plan needs and interactions to ensure consistent implementation of contractual obligations.
CommonSpirit Health has more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services. They are committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside their hospitals and out in the community.