- CVS Health (Blue Bell, PA)
- …a high-performing actuarial team supporting CVS Health and Aetna's Government Services Medicare Advantage business. The primary responsibility of this role will be ... experience. Should be at/near ASA (Associates of the Society of Actuaries) Medicare experience is desired (not required) Strong communication skills and excellent… more
- CVS Health (Harrisburg, PA)
- …Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We ... 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 solutions company, we reach millions of Americans… more
- CVS Health (Harrisburg, PA)
- …**Work Schedule: Start times between 7:50 am and 11:45 am EST** The Worklife Resource Consultant is part of the Worklife Team and provides education about community ... resources, resource needs assessment, and community and/or national referrals to a variety of customers for a variety of needs including childcare, elder/adult care, and basic/everyday needs. The WLC is responsible for providing Worklife consultation and… more
- Humana (Harrisburg, PA)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve ... analysis of situations or data requires a case-by-case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director's work… more
- Fresenius Medical Center (Harrisburg, PA)
- …options: + Educates on the availability of alternative insurance options (ie, Medicare , Medicaid, Medicare Supplement, State Renal programs and COBRA). + ... + Discusses insurance options when insurance contracts are terminated. Responsibilities involving Medicare and Medicaid include but are not limited to: + Determining… more
- Humana (Harrisburg, PA)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid/ Medicare . Looks for long term improvements of encounter submission processes. Understands… more
- CVS Health (Harrisburg, PA)
- …Tracking Module (CTM) Senior Coordinator, you will be part of the Medicare Complaints Tracking Module (CTM) Team, responsible for researching and resolving ... complaints received via the Centers for Medicaid and Medicare Services (CMS). In this role, you will manage...In this role, you will manage a queue of Medicare complaints. These complaints can include various issues ranging… more
- UPMC (Pittsburgh, PA)
- …is hiring temporary sales agents to assist with growing membership during the Medicare Annual Enrollment Period. The temporary sales agents will sell Medicare ... Needs plans by handling inbound calls and making outbound calls to Medicare beneficiaries, offering Medicare education, benefit reviews, plan recommendations,… more
- CVS Health (Blue Bell, PA)
- …models and metrics as well as assists with target setting for PCP Focused Medicare Value Based Contracts (VBC). The role will use Actuarial modeling to understand ... the value created by our VBC Medicare collaboration models as well as any potential financial...potential financial risk to our provider partners associated with Medicare pricing or CMS regulations. This role will assist… more
- Humana (Harrisburg, PA)
- …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...HR. DVACO's MSSP participation accounts for the region's largest Medicare ACO grouping, with more than 2,000 physicians and… more