- Excellus BlueCross BlueShield (Rochester, NY)
- …and communication with Insured, Insured's family, care providers, and adjudication of the claims . All work is directed under the terms and conditions of the various ... the Company. + Evaluates Insured's condition through review of field assessments, medical records, etc. Determines benefit eligibility based on the criteria outlined… more
- CVS Health (Albany, NY)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...advocate for themselves. The TOC team will review prior claims to address potential impact on current case management… more
- CVS Health (Albany, NY)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...exposure to benefits and/or contract interpretation, including experience with claims systems and network databases. + 3-5 years of… more
- Highmark Health (Buffalo, NY)
- …and efficiency metrics, accountable care organization development and support, patient centered medical home, and electronic health records. + Experience may be ... and/or hospital resources for providers employed in multi-specialty groups or health systems. + For value based contracts addressing government markets, directly… more
- Elevance Health (Latham, NY)
- …coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. **How you ... will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care… more
- Elevance Health (Latham, NY)
- …coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site ... will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care… more
- Independent Health (Buffalo, NY)
- …**Overview** The Provider Contracting & Reimbursement Analyst-Intermediate will analyze utilization, claims , membership, and cost data in support of Network Contract ... equitable, and market competitive reimbursement designed to achieve value for the health plan, provider partners, and members. This individual will be responsible… more
- Elevance Health (Middletown, NY)
- …care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. **How you will make an impact:** + Responsible ... identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term services… more
- Catholic Health Services (Roslyn, NY)
- Overview Catholic Health is one of Long Island's finest health and human services agencies. Our health system has over 16,000 employees, six acute care ... hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health , our primary focus is… more
- Kelly Services (New York, NY)
- **Account Manager - Medical Benefits** **Location: Brooklyn, NY or Manhattan, NY - Hybrid** **Salary: $70,000-85,000** **Direct Hire Opportunity!** **Kelly** has an ... successful **Account Manager** to join a leading **3rd party Health Benefits Administrator** based out of their **Brooklyn, NY**...company will provide. + Resolve group level issues with claims , funding, eligibility etc. as needed by enlisting the… more
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