Maintain ongoing caseload of individuals through the utilization of evidence based approaches to promote engagement and achievement of health goals
Conducts periodic telephonic and SMS outreach to ensure timely follow-up to members
Assist individuals in securing connection to community supports by scheduling appointments, managing referrals, and ensuring timely follow-ups
Pair Team is an innovative, mission-driven company reimagining how Medicaid and Medicare serves the most underserved populations. As a tech-enabled medical group, they deliver whole-person care, and leverage AI and automation to reduce administrative burden. They are deeply collaborative with nurses, social workers, community health workers, and medical professionals.
Manage multiple channel interactions professionally and efficiently.
Effectively present products/services to providers with integrity, understanding, and accuracy.
Focus on provider retention through first call resolution and maintain positive relationships.
Capital Blue Cross promises to go the extra mile for its team and community. Employees consistently vote it one of the “Best Places to Work in PA”, valuing professional/personal growth by investing heavily in training and continuing education.
Researches requests for review of resolvable claims from providers.
Compiles information related to member appeals that request an Executive Review.
Provides copies of necessary documents and submits information to the Appeals and Policy Manager for review.
PEHP Health & Benefits is a division of the Utah Retirement Systems that serves Utah’s public employees through competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. They embrace both a public mission and a commitment to creating customer value.
Manage the insurance claims process and provide customer service to clients.
Analyze and approve claims and determine coverage based on medical necessity.
Resolve discrepancies, secure proper reimbursement, and follow regulations and guidelines.
CommuniCare Family of Companies delivers person-centered care as a national leader in post-acute care. They operate over 150 facilities, employing more than 19,000 employees across six states, and are dedicated to improving the lives of seniors.