Supports outbound calls and data/benefit analysis related to various clinical pharmacy programs.
Performs advanced administrative/operational/member support duties.
Initiates and responds professionally to a high volume of calls in a timely and efficient manner.
Capital Blue Cross promises to go the extra mile for their team and community. It appears to be a large company, that values its employees, as they are consistently voted one of the “Best Places to Work in PA”.
Responsible for supporting the implementation, maintenance, analysis, and quality assurance of ConnectiveRx pharmaceutical affordability programs.
Accountable for program set-ups and maintenance, performs quality control on program setups and updates, and investigates adjudication outcomes and data discrepancies.
Applies business rules consistently to ensure operational accuracy and program integrity and works independently on routine tasks.
ConnectiveRx helps pharmaceutical manufacturers untangle the complex prescription process. They bring together diverse voices to allow patients to build trusting relationships with their medication brands. ConnectiveRx offers comprehensive benefits including medical, dental, vision, life, and disability insurance.
Responsible for processing insurance claims accurately and efficiently.
Analyze claim data to identify trends, errors, and potential irregularities.
Serve as a liaison between departments to support seamless claims resolution and continuous process improvement.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a fast-growing company serving over 200,000 seniors in 1,500+ communities across 32 states.
Support daily pharmacy operational workflows and administrative tasks to ensure timely and accurate prescription processing.
Provide frontline operational support to clinicians and internal teams for routine pharmacy workflow questions and requests.
Collaborate with the CX team to assist with basic prescription-related member issues and inquiries.
Lifeforce is the world's largest longevity medicine program. They bring together diagnostics, clinical experts, health coaches, and customized protocols to help people understand and optimize their bodies, functioning now and decades to come. They seem to have a modern and proactive company culture.
Take incoming requests for appeals ensuring customer service and maximizing productivity.
Work with appeals team for multiple lines of business ensuring appeal submission for review.
Maintain quality standards, remain current on updated processes, and follow SOPs and HIPAA guidelines.
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.
Conduct high-volume calls with patients, providers, and pharmacies using established protocols.
Collaborate with patients to remove barriers to medication adherence and escalate clinical barriers to a pharmacist.
Accurately document all interactions, outcomes, and identified barriers in appropriate systems.
Aledade empowers independent primary care practices to deliver better care and thrive in value-based care. Founded in 2014, they've become the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Review and process patients’ enrollment forms for the Patient Assistance Program.
Assist patients on the phone with PAP program enrollment by verifying pre-screening and qualifying tasks.
Notify patients and healthcare providers of approvals, denials, and any next steps needed to continue the enrollment process.
CareTria aims to help patients access coverage for their prescribed medications. We provide telephone support and administrative functions. The company offers comprehensive benefits and is an Equal Opportunity Employer, indicating a commitment to a positive and inclusive work environment.
Oversee prior authorization technicians and administrative PA functions.
Analyze data and provide staffing, workflow, and system enhancement recommendations.
Investigate/resolve escalated issues from clients and providers.
Judi Health is an enterprise health technology company providing a suite of solutions for employers and health plans. They have a comprehensive Enterprise Health Platform that consolidates all claim administration-related workflows in one scalable, secure platform.
Determines coverage, investigates the claims, determines liability, sets and adjusts reserves, evaluates the claim, negotiates a settlement, authorizes and pays the claim; may deny claims.
Reviews lawsuit documentation and supporting documents, claims file, investigation, etc. Establish actions to be taken to resolve lawsuit.
Accountable for security of financial processing of claims, as well as security information contained in claims files.
Liberty Mutual is an insurance company that values hard work, integrity and commitment to make things better. They offer benefits that support your life and well-being and strive to create a workplace where everyone feels valued, supported, and can thrive.
Performs advanced level work related to denial management.
Processes and follows up on all appeal types, at an expert level, to all payers.
Takes actionable steps to resolve open claims, including refiling or appealing claims, or resolving manual tasks.
US Anesthesia Partners is a company that provides anesthesia services. They provide equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, or disability.
Directly lead and manage a team of Patient Support Associates to ensure medication adherence or timely prior authorization.
Proactively manage support in assigned hospitals and/or clinics to ensure patients receive medications on-time.
Provide front-line supervision and ongoing coaching and performance management to Patient Support team.
Shields Health Solutions is a specialty pharmacy management service provider. They are a fast-growing company that values motivated self-starters with a positive outlook and a focus on high-quality work.
Analyze Auto Bodily Injury and Property Damage claims on behalf of clients to determine benefits due.
Ensure ongoing adjudication of claims within service expectations and industry best practices.
Negotiate settlement of claims within designated authority and communicate claim activity with the claimant and the client.
Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.
Make outgoing calls for messages received regarding new claims
Enter new claim information into the client website
ClaimsPro LP is an international programs group that handles a variety of claims including auto physical damage and property damage. They are Canada's largest privately owned provider of insurance services empowering employees with the tools and technology to provide clients with the highest quality of service.
Analyze "trigger reports" to identify potential financial exposure early in the claims process.
Gather clinical information to evaluate liability and make recommendations to stakeholders.
Provide cost containment by managing Stop Loss claims and negotiating prices for medical services.
Ullico is the only labor-owned insurance and investment company and has been a partner of the labor movement for over 95 years. The company provides insurance products for members, leaders, and employers, as well as investments.
Act as a designated support resource for assigned Account Managers.
Responsible for troubleshooting escalated items related to claims, eligibility, and general account maintenance.
Collaborate with cross-functional internal teams for client issue resolution.
SmithRx is a rapidly growing, venture-backed Health-Tech company that aims to disrupt the Pharmacy Benefit Management (PBM) sector. They have hundreds of thousands of members onboarded since 2016 and pride themselves on a mission-driven and collaborative culture.
Review, investigate, and manage PIP claims from initial notice through resolution.
Analyze medical records, treatment plans, billing submissions, and police reports.
Evaluate claim validity and determine exposure based on applicable state PIP regulations and policy guidelines.
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