• Pharmacy Government Stars Coordinator

    Intermountain Health (Albany, NY)
    …+ Pharmacy + Pharmacy Benefits Management (PBM) + Medical Prescriptions + Pharmacy Claims + Customer Service + Problem Resolution + Phone Calls ... (Inbound/Outbound) + Oral Communication + Written Communication + Group Problem Solving + Medicare Part D + Medicaid + Mentorship/Coaching + Decision Making + Microsoft Excel **Minimum Qualifications:** + Pharm D. degree or Masters degree from an accredited… more
    Intermountain Health (08/20/25)
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  • College Intern I - Fall 2025 - Claims…

    Excellus BlueCross BlueShield (Rochester, NY)
    …(3) or more hours at a time. + Ability to travel across the Health Plan service region for meetings and/or trainings as needed. One Mission. One Vision. One IDEA One ... you. Together we can create a better IDEA for our communities. At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our… more
    Excellus BlueCross BlueShield (08/20/25)
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  • Representative, Provider Relations HP (Must Reside…

    Molina Healthcare (NY)
    …setting. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : * 2 - 3 years customer service , provider service , or claims experience in a managed care ... and procedures while achieving the highest level of customer service . **Job Duties** This role serves as the primary...that services Molina members, including but not limited to Fee-For- Service and Pay for Performance Providers. It is an… more
    Molina Healthcare (08/02/25)
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  • Senior Provider Relations Representative

    Molina Healthcare (Buffalo, NY)
    …setting. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : * 3 - 5 years customer service , provider service , or claims experience in a managed care ... and procedures while achieving the highest level of customer service . **Job Duties** This role serves as the primary...that services Molina members, including but not limited to Fee-For- Service and Pay for Performance Providers. It is an… more
    Molina Healthcare (06/15/25)
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  • Member Solutions Center Supervisor

    CSEA (Albany, NY)
    …year of supervisory experience.ORA satisfactory combination of education, customer service -related work experience, voluntary insurance claims administration or ... and departmental compliance to ensure members are receiving excellent customer service .5. Assists with answering phone inquiries from members, nonmembers, and… more
    CSEA (08/13/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Albany, NY)
    …in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program ... of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more
    Molina Healthcare (08/15/25)
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  • Underwriter

    CVS Health (Albany, NY)
    …that align with strategic goals. + **Drive Strategy:** Collaborate with sales, claims , and customer service teams to develop tailored underwriting strategies ... based on market trends and business objectives. + **Mentor & Guide:** Share your expertise by mentoring peers, reviewing work for accuracy, and identifying training opportunities. + **Ensure Compliance:** Conduct audits, track allowances, and ensure all… more
    CVS Health (07/09/25)
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  • Business Process Analyst - HNAS

    Highmark Health (Albany, NY)
    …Analyst or Business Process Analyst role or experience in a related operational area (eg claims , billing, customer service , etc.) **Preferred** + 1 - 3 years in ... the Health Insurance Industry **LICENSES OR CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Analysis of business problems/needs + Written & Oral Presentation Skills + Business Analysis + Business Process Design + Business Process… more
    Highmark Health (06/17/25)
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  • RN Crisis Care Triage

    Sedgwick (Albany, NY)
    …hospital visit for the claim. + Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in ... guidelines. + Maintains ongoing communication with the client, Client Service Director, and Claims Examiner until the assigned Field Case Manager arrives onsite.… more
    Sedgwick (07/25/25)
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  • Personal Lines Account Manager

    World Insurance Associates, LLC. (Slingerlands, NY)
    …of advocacy, excellent service , and professional communication + Handling renewals, service requests, claims , billing and new policies + Maintain a thorough ... products and services from major providers, combined with attentive service from local agents. Founded in 2011, World is...from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's… more
    World Insurance Associates, LLC. (08/08/25)
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