• Health Care Sales Enroller

    MVP Health Care (Schenectady, NY)
    …Child Health Plus, Essential Plan, Qualified Health Plans (QHPs), HARP, Off-Exchange, Medicare Advantage (MA) products, and Dual Eligible Special Needs Plans ... (D-SNP). + **Conduct both individual and group outreach activities** to present our innovative health care solutions on- and off-site at various events-from health fairs and community expos to festivals and holiday-themed gatherings-ensuring MVP's presence is… more
    MVP Health Care (01/08/26)
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  • Sr Manager Key Provider Contracts

    Health Care Service Corporation (Chicago, IL)
    …Job Qualifications:** + MBA or MHA. + Health care industry experience. + Medicare Advantage knowledge and expertise. + Commercial, Affordable Care Act knowledge ... and/or Medicaid MCO. + Knowledge a plus. **This is a Flex (Hybrid) role: 3 days in office; 2 days remote.** **Sponsorship is not available.** \#LI-LO1 \#LI-Hybrid **Are you being referred to one of our roles? If so, ask your connection at HCSC about our… more
    Health Care Service Corporation (01/08/26)
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  • Float Medical Assistant

    CenterWell (Louisville, KY)
    …Care has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality ... primary care combined with an excellent patient experience. CenterWell Senior Primary Care has experience in both the treatment and management of most chronic and acute-care conditions. The practices also provide health education and value-added, well-being… more
    CenterWell (01/08/26)
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  • Medical Collections Specialist

    Robert Half Accountemps (Sacramento, CA)
    …* Display a strong comprehension of insurance products such as HMO, PPO, and Medicare Advantage plans * Exhibit strong skills in writing appeals and effectively ... work with insurance companies to resolve denied or underpaid claims * Comfortably communicate with patients regarding their balances and explain adjudication outcomes * Apply analytical skills to make sound decisions on claim resolutions * Exhibit efficiency… more
    Robert Half Accountemps (01/07/26)
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  • Disease Burden (HCC) Business Intelligence…

    Corewell Health (Grand Rapids, MI)
    …and detail-oriented Risk Adjustment Reporting Developer to support our organization's Medicare Advantage , ACO, ACA, and other risk-based programs. This ... role is critical in reporting, trend analysis, RAF analytics, and provider opportunity targeting. The ideal candidate understands CMS risk-adjustment methodologies, coding impacts, and can turn data insights into actionable strategies for providers, CDI, and… more
    Corewell Health (01/06/26)
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  • Medical Record Retrieval Specialist

    Robert Half Office Team (Mountlake Terrace, WA)
    …supporting risk adjustment and quality initiatives across various business lines, including Medicare Advantage and Commercial programs. This position is remote, ... offering flexibility while requiring strong organizational and communication skills to meet project deadlines effectively. Responsibilities: * Retrieve electronic medical records from provider systems and copy service platforms. * Generate and manage letter… more
    Robert Half Office Team (01/06/26)
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  • Medical Review & Appeals Director (Hybrid)

    CareFirst (Baltimore, MD)
    …Qualifications:** + Significant experience with Government programs including Maryland Medicaid, Medicare Advantage and DSNP. **Knowledge, Skills and Abilities ... (KSAs)** + Knowledge of NCQA requirements of utilization review, Case Management standards and guidelines, appeal rights and responsibilities, and Regulatory requirements at the state and federal level for health care administration and Carrier standards. +… more
    CareFirst (01/06/26)
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  • Account Consultant IV - Public Sector (Remote)

    CareFirst (Baltimore, MD)
    …of underwriting principles; group health/life insurance financial/funding mechanisms; stop loss, medicare advantage , wellness, clinical, managed care and point ... solutions, healthcare delivery systems, including pricing methodologies and cost reimbursement mechanisms for both self-funded and fully insured business. + Knowledge and understanding of CRM and other client management tools. + Strong customer service… more
    CareFirst (01/06/26)
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  • Medical Assistant S. Summerlin

    CenterWell (Las Vegas, NV)
    …Care has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality ... primary care combined with an excellent patient experience. CenterWell Senior Primary Care has experience in both the treatment and management of most chronic and acute-care conditions. The practices also provide health education and value-added, well-being… more
    CenterWell (01/06/26)
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  • Medical Records Review Nurse / Medical Records…

    System One (Baltimore, MD)
    …It includes pre- and post-claim medical review for Commercial, FEP, and Medicare Advantage Plans, as well as HEDIS-related activities. The role ... also involves medical underwriting and risk assessment, ensuring compliance with corporate and medical policies. Essential Functions + Claims Review & Analysis (35%) Review and analyze professional and institutional claims using critical thinking, nursing… more
    System One (01/06/26)
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