- CVS Health (Albany, NY)
- …and other key personnel. Our TOC Coaches are frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address ... potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are designed to use a holistic approach to identify the need for a referral to clinical resources for assistance in functionality. Additional… more
- Molina Healthcare (Rochester, NY)
- …minimal direction, works directly with the Plan's external providers to educate, advocate , and engage as valuable partners, ensuring knowledge of and compliance with ... **Required Experience** + 2 - 3 years customer service, provider service, or claims experience in a managed care setting. + Working familiarity with various managed… more
- Molina Healthcare (Albany, NY)
- …with the Plan's highest priority, high volume, strategic providers to educate, advocate and engage as valuable partners. + Requires an in-depth knowledge of ... setting. **Required Experience** + 3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5 years' experience in managed… more
- New York State Civil Service (Albany, NY)
- …12223 Duties Description Duties include but are not limited to:* Assist, advise, and advocate for veterans as well as their families and survivors on a variety of ... and entitlement criteria to veterans and/or their families; the analysis of claims for veteran benefits; the preparation of rating decisions; and/or the direction… more
- CHA Consulting, Inc. (Albany, NY)
- …contract review and negotiation, mergers and acquisitions, litigation and claims management, negotiation of disputes with contractors and subcontractors, and ... possible. We as an organization celebrate the values of inclusion and equality, and advocate for the full participation of all people in an environment free of… more
- Humana (Albany, NY)
- …impacts, and mitigation planning. **Advocacy and Leadership:** + Market Advocacy: Advocate for the market's technical needs and assist in navigating approvals ... processes + Solid understanding of healthcare operations, particularly around claims processing, enrollment, provider data management and clinical operations;… more
- Molina Healthcare (New York, NY)
- …general supervision, works directly with the Plan's external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance ... SKILLS & ABILITIES** : * 3 - 5 years customer service, provider service, or claims experience in a managed care setting. * 3+ years experience in managed healthcare… more
- HUB International (Melville, NY)
- …not limited to, with over 50 lives. **Specific responsibilities include:** + Resolve claims and administrative issues + Act as liaison with insurance carriers and as ... an advocate for clients + Design benefit plan in conjunction with client needs and financial resources + Process renewals, including competitive bidding, providing… more
- MTA (Jamaica, NY)
- …denial letter within time limits. Calculate the cost or liability of claims . Negotiate stipulations of settlement where appropriate. Analyze cases and make decisions ... coordinate multiple assignments and issues simultaneously. + Experience as first chair advocate at arbitrations or hearings. + Experience in or knowledge of… more
- The Cigna Group (New York, NY)
- …of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales ... **About Cigna Healthcare** Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers… more