Be the primary point of contact for all providers.
Provide professional, accurate and timely responses to all provider inquiries.
Maintain a current knowledge of all contract requirements and objectives.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans.
Provide customer service and interpersonal communication skills to support the ICE law enforcement mission.
Maintain public and community relations by answering incoming calls and processing web tips.
Review, analyze, and process tips for further action.
SteerBridge Strategies is a CVE-Verified Service-Disabled, Veteran-Owned Small Business delivering professional services to the U.S. Government and private sector.
Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.
Responsible for economic credentialing and provider enrollment with contracted managed care and governmental plans.
Communicating provider participation information to internal and external customers.
Ensures compliance with regulatory agencies and maintains a working knowledge of statues and laws.
The West Virginia University Health System is West Virginia’s largest health system and the state’s largest employer. They have more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues.
Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Audit internal provider data against database records to ensure 100% accuracy before submission.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.
Manages client denials and concerns through analytic review of clinical documentation.
Delivers final determination based on skillsets and partnerships with Humana parties.
Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.
Humana Inc. is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, they strive to make it easier for millions to achieve their best health, delivering needed care and service.
Provide quality customer service experience to consumers and customers.
Communicate effectively with consumers via various channels (telephone, email, chat, social media, etc.).
Problem solve in a professional and effective manner.
Jobgether is a platform that uses an AI-powered matching process to connect job seekers with potential employers. They ensure applications are reviewed quickly, objectively, and fairly, and provide a shortlist of top-fitting candidates to hiring companies.
Showcase customer service and data entry skills as part of the healthcare team.
Involved in claims adjudication and/or provider credentialing.
Support customers by phone, email and chat.
Sutherland helps customers globally achieve greater agility and transform automated customer experiences. As a digital transformation company they have been in business for over 35 years and are Great Place to Work certified with nearly 40,000 employees.
Manage a caseload of in-progress applications through the underwriting process
Coordinate and follow up on medical exam bookings with vendors and clients
Handle inbound calls and respond to client emails
PolicyMe is Canada’s leading digital insurance solution, offering straightforward and affordable financial protection for families. They operate with a remote-first culture and have sold over $10 billion in insurance coverage since 2018.
Prepare and submit credentialing and enrollment packets.
Maintain accurate provider files and track expirations.
Provide assistance to the billing team during staff absences.
Modena Health and Modena Allergy & Asthma are leading medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona and plans for national expansion. They are physician-led and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.
Responsible for accurately and respectfully responding to inquiries from employees/members, providers and clients in a high volume call center.
Seamlessly navigate multiple system applications/screens and resources to accurately respond to inquiries.
Thoroughly and accurately document all inquiries and actions taken using applicable software applications.
Luminare Health helps clients and brokers design custom self-funded healthcare plans providing innovative solutions, flexibility, complete data transparency, and member-centered support. They rely on their decades of industry experience and proven, data-driven results to deliver optimal benefits solutions, customized to meet our clients’ needs.
The Sales Support Specialist works with Account Managers, executing business strategies and maintaining relationships with Manufacturers and Kroger team members. This role supports Account Managers, ensuring seamless execution of sales activities and managing contract entry. This position requires attention to detail, clear communication, and the ability to work in a fast-paced, deadline-driven environment.
C.A. Fortune aspires to maintain our position as the nation’s leading consumer brands agency, offering comprehensive solutions to clients from sales to e-commerce.
Support clinical staff by gathering data to complete the medical necessity review process.
Create and send letters to providers and/or members to communicate information.
Collaborate with care management teams and stakeholders to provide optimal service.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, and they’ve built their reputation on over 80 years’ worth of trust. They are motivated by the well-being of their members, putting them first and committing to sustainability and innovation.
Provides data management support services to Dignity Health’s CI/ACO Networks, Employer Relations and Valued Based Operations (VBO).
Within the Salesforce platform, this individual gathers and maintains accurate provider data, performs periodic provider data reconciliations with multiple data sources.
Maintains and transmits fee schedules, as necessary, to third-party administrators (TPA's) and other appropriate stakeholders.
Dignity Health MSO builds a system-wide integrated physician-centric, full-service management service organization structure. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers.
Contact and communicate with providers to obtain required medical record documentation.
Respond to telephone inquiries promptly, professionally, and efficiently to provide resolution.
Analyze provider questions to determine the best use of resources to resolve the situation.
Empower AI provides federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. They leverage three decades of experience solving complex challenges in Health, Defense, and Civilian missions and are headquartered in Reston, VA.
Provide quality customer service experience to consumers and customers.
Communicate effectively with consumers via all channels including telephone, email, chat, and social media.
Analyze trends in customer reviews and social sentiment for actionable insights.
Jobgether uses an AI-powered system to ensure applications are reviewed objectively and fairly. They identify the top-fitting candidates and share the shortlist with the hiring company, with final decisions managed by the internal team.
Review and process applications in all DOHMH license applications and all relevant information.
Under supervision, perform clerical work including routine data processing functions, recording, researching, checking and maintaining records and furnishing information to licensing applicants.
Check records for accuracy of information and for conformity with established policy and procedures.
The NYC Department of Consumer and Worker Protection (DCWP) protects and enhances the daily economic lives of New Yorkers to create thriving communities. DCWP licenses nearly 45,000 businesses in more than 40 industries and enforces key consumer protection and workplace laws.
Manage the full enrollment process for Medicare and Medicaid across applicable states.
Prepare, complete, and submit all required enrollment applications and documentation.
Track application status and follow up with agencies to drive timely approvals.
BetterHelp aims to improve mental health and make mental healthcare accessible. They are the world’s largest online therapy service with over 30,000 licensed therapists, and they value employee mental health, investing in their team’s well-being and professional development.
Directly communicate with insurance companies to facilitate the approval of medications.
Navigate pharmacy operating systems to input data and prepare action plans for follow-up.
Communicate directly with patients over the phone to assist them in medication compliance.
Shields Health Solutions provides integrated pharmacy solutions. They partner with hospitals and health systems to improve patient outcomes and create financial value.