Provider Relations is responsible for provider relationship, management, and performance of high quality, cost-effective, competitive networks in multiple lines of business to retain and grow Delta Dental's business. The Provider Network Ambassador represents Delta Dental in the provider community working to create a best-in-class provider experience with responsibility in managing provider networks and cultivating relationships with providers and their office staff so they reflect our service to our enrollees. This position requires relationship management skills, is self-motivated, and brings enthusiasm, passion and energy to the job. The position encompasses a full range of provider relations activities and service interactions with provider partners nationwide. This role will engage with providers, dental office staff, local dental societies/dental associations and work collaboratively with internal business partners across the enterprise.
2+ w/Bachelor's degree.
Additional experience may be accepted in lieu of education or degree.
2+ years of dental managed care or related health care experience. A minimum of 3 years of front office dental administration and/or back office dental assisting experience preferred. Demonstrated experience in provider network management, customer service and/or account management.
Demonstrates curiosity and interest in gaining understanding of business practices and related topics.
Ability to clearly present written information and findings.
Strong organizational, time management, assignment prioritization and project management and delivery skills.
Ability to successfully apply Professional Selling Skills (PSS) principles.
Ability to interpret various forms of information, including key information about marketplace and provider perceptions.
Ability to effectively interface with employees at all levels.
Knowledge of Current Dental Terminology (“CDT”) codes and dental nomenclature is preferred.
Proficient in Microsoft Office applications (Word, Excel, PowerPoint, Outlook, Teams).
Strong communication, presentation, negotiation and listening skills.
Ability to operate in an environment of rapidly changing priorities is preferred.
Knowledge of dental and general insurance procedures is preferred.
Ability to travel by car and air and sustain company expenses for a period of one month if needed.
Cultivates and maintains relationships with external and internal business partners.
Ability to obtain and maintain sufficient credit to manage related job expenses including, but not limited to, applying to and being approved by a third party charge card agency to receive the company's corporate charge card.
Able to operate and maintain a personal car for company business in a proper, safe and responsible manner.
Licenses
• DL NUMBER - Driver License, Valid and in State. Must have a valid driver's license and ability to maintain an acceptable Department of Motor Vehicle record and purchase and maintain $250,000/$500,000 collision damage liability insurance policy for the car which they will receive the auto allowance (Required for work travel) Upon Hire Req'
Base Pay Information
The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.
Pay Grade 18. $56,900 - $119,200
Provides consultative support to network providers to facilitate business efficiency and success by promoting digital online tools and value-add services.
Builds and sustains strong relationships with providers and dental office staff; enhances the overall provider experience to advance Delta Dental's interest in the provider market to be the preferred and trusted partner.
Ensures provider network size and stability meet client growth needs by reducing provider turnover while maintaining high quality, cost-effective, competitive networks. Works closely with Network Development and Sales teams.
Conducts provider outreach, education and training, and on-site dental office reviews to ensure provider networks in assigned geographic areas are compliant with all applicable regulatory and contractual requirements.
Partners with internal stakeholders to monitor provider performance to contractual obligations and conducts follow-up to gain provider compliance.
Conducts virtual service interactions or face to face interactions with key regional and local provider partners across designated territory, monitors utilization patterns of providers, facilitates issue resolution, interprets statistics and recommends practice management tools to facilitate effective plan administration.
Assesses the network's appointment availability through service calls; verifies and confirms reported appointment access and availability deficiencies and facilitates network compliance.
Collaborates with cross-functional teams within the enterprise, dental provider community and organized dentistry to gain perspective on provider market trends, issues and areas of opportunity in service to the dental profession.
Reviews and analyzes competitor information and internal data to determine network retention strategies; evaluates and determines cost effectiveness of retaining providers in key markets.
$56.9k-119.2k yearly Auto-Apply 22d ago
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Payment & Outcomes Rules Manager
Delta Dental Ins 4.9
Remote Delta Dental Ins job
The Manager of Payment Rules & Outcomes is a key strategic leader in managing Delta Dental's health care industry rule practices, rule architecture, business capabilities, and administration of clinical and non-clinical policies to ensure quality outcomes and accurate payment. This role leads a team of analysts that support identification of new rules to enable policy and ensure quality outcomes and accurate payments, while also monitoring the efficacy of existing rules. This Manager is a trusted thought partner to support the various Quality and Enterprise efforts driving quality outcomes and delivering quality of care.
8+ years w/Bachelor's degree; 1+ years supervisory/management.
Additional experience may be accepted in lieu of education or degree.
Experience in claims and/or clinical outcome determination preferred.
Experience in aggregating internal and external complex information to address business problems and working cross-functionality to build the story and deliver the message to Sr. Leaders in support of business decisions.
Strong people-leadership skillset, including talent development and the ability to realize strategies through a team.
High detail orientation with strong analytical, critical thinking and problem-solving skills.
Excellent organizational/time management and project management skills.
Extensive knowledge of health care industry.
Excellent interpersonal, verbal, and written communication skills, including proven ability to collaborate and influence across all functions and levels of the organization.
Proven ability to resolve conflict and facilitate decision-making.
Strong presentation skills. Should be comfortable with presenting to all levels of management.
A problem solver and planner, has strong quality control, adaptability, and customer service skills.
Ability to break down complex problems into pieces that can be solved with data, analysis, assumptions, and judgment.
Ability to synthesize large amounts of complex information to determine correlations in the data and summarize in a way that is digestive to stakeholders.
Ability to represent the business and work cross-functionally to ensure the enterprise is deploying the right rules and optimal solution patterns for accurate policy and payment administration.
Advanced technical knowledge is preferred.
Base Pay Information
The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.
Pay Grade 22. $92,500 - $200,400
Oversees business and clinical policy administrative rules and business “ownership” for the tool(s) enabling claim or clinical outcome rules; including oversight of any external third-party partners that are administering claim outcome and/or payment rules on Delta Dental's behalf to ensure consistent and accurate outcomes and performance.
Leads a team of Outcome Rules Analysts that work cross-functionally to ensure Delta Dental has the right monitoring and controls in place to continuously and proactively evaluate rules in production, ensuring accuracy and effectiveness.
Leads cross-functional discussions with various Data, Analytics, Reporting, Insights, Technology and Business stakeholders to discuss new opportunities within the claims and clinical ecosystem, and to formulate recommendations and comprehensive remediation plans inclusive of holistic business cases for any new, enhanced or eliminated rules.
Ensures outcome rules are appropriately accessible and transparent both internally and externally, and supports enterprise-wide educational opportunities.
Leads health care industry research to ensure best practice rule management methodologies are documented, implemented, and communicated to stakeholders regularly.
Develops and maintains a comprehensive approach to analysis and reporting of outcome rule performance, trends and opportunities that are accessible to stakeholders.
Leads cross-functional discussions to influence Policy and Payment Quality Management strategy, prioritization and multi-year roadmaps.
Develops and maintains strong partnerships with functional leaders (including Business Directors, Senior Product Managers, Technology Managers, and other Product Managers), across the enterprise to drive focus on business objectives.
Manages and develops multi-disciplinary teams to achieve strategic objectives, encompassing determining staffing needs, setting goals, monitoring performance, interviewing, selecting, coaching, and evaluating the performance of all direct reports, overseeing, and maintaining department budgets.
$92.5k-200.4k yearly Auto-Apply 3d ago
Sales Executive - Employee Benefits
World Insurance Associates 4.0
Seattle, WA job
World Insurance Associates (“World”) is a unique financial services organization with a global network of brokers and specialists who empower people to make informed decisions to improve their risk management outcomes, modernize their benefits programs, and help them achieve their long-term financial goals. Founded in 2011, World is one of the fastest-growing, Top 25 insurance brokers in the U.S. with nearly 3,000 employees in more than 300 offices across North America and the U.K. World specializes in personal and commercial insurance, surety and fidelity bonding, employee and executive benefits, investment advisory and retirement plan services, and payroll & HR solutions.
Employee Benefits Sales Producer - Employee Benefits Client Advisor
Position Overview
World's Client Advisors bring comprehensive risk management and employee benefit solutions to businesses and individuals. Your primary focus is identifying, prospecting, cultivating, and closing new employee benefits clients (small, medium, and large businesses) by leveraging World's unique capabilities and broad market access.
While your main focus is on designing and delivering employee benefits programs-including medical, dental, vision, life, disability, and voluntary benefits-you are also empowered to help clients with complementary solutions such as commercial and personal lines insurance, 401(k) and retirement plans, and payroll and human resources outsourcing services.
World's investment in a full suite of insurance and business solutions means you can engage with organizations of any size and industry to deliver meaningful value to your clients.
Help clients experience a modern alternative to employee benefits
Together, our Employee Benefits team helps clients build a capital-efficient and employee-centric program designed to mitigate their unique exposures. Using modern approaches, our highly technical team utilizes data and forensic underwriting to drive superior financial outcomes while helping clients attract, retain, and motivate talent. We are growing rapidly, and we are looking for future leaders.
To learn more about us, please visit ******************************
Our Client Advisors ...
Are responsible for identifying, soliciting, and closing new Employee Benefits business
Utilize cold calls, prospecting emails, mail, professional associations, and networking to identify, contact, cultivate and close new business opportunities
Identify opportunities to bring all of World's solutions to our clients - beyond employee benefits (and enjoy the financial rewards of doing so)
Identify exposures, make recommendations, and create custom programs to eliminate gaps in coverage
Identify opportunities to round out accounts for existing clients
Drive account retention and maintain client relationships through renewal workflows.
Our Employee Benefits Client Advisors . . .
. . .Bring 3-5 years+ of experience working in an insurance brokerage or carrier
. . .Are personable and highly motivated to grow personal success
. . . Leverage excellent listening skills and consistently demonstrate a strong customer focus as well as a sustained sense of urgency and ability to meet deadlines
. . . Are consultative and bring a positive and resourceful approach to dealing with prospective clients and associates
. . . Have experience with Employee Benefits and Sales software platforms such as BenefitPoint and sales CRM's like HubSpot
. . . Work independently and enjoy a high degree of interaction with team members
. . . Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior, and effort to achieve goals and objectives
. . . Consistently demonstrate effective written and verbal communication skills
. . . Possess a strong attention to detail and the ability to solve problems with minimal assistance
. . . Demonstrate the highest levels of discretion surrounding sensitive information
Compensation
As a World Insurance Client Advisor, your compensation is tied to your effort and your performance. We offer a base salary plus commissions as well as a full suite of employee benefits, including a 401(k) match that is immediately fully vested. The base salary range for this role is $60,000 to $200,000+, depending upon your level of experience. The base salary depends on your experience and your ability to drive revenue. Your base salary grows as your book of business grows, with tremendous potential to significantly exceed the top of this range.
Equal Employment Workforce and Workplace
World celebrates and supports differences amongst its employees. World knows employing a team rich in diverse thoughts, experiences, and opinions allows World's employees and World's work environments to flourish. World is honored to be an equal opportunity workplace, dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, World makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of World's business.
TO EXECUTIVE SEARCH FIRMS AND STAFFING AGENCIES:
World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Human Resources Talent Department.
#LI-MS1
$60k-200k yearly Auto-Apply 2d ago
Customer Service Specialist
Delta Dental Washington Dental Service 4.9
Delta Dental Washington Dental Service job in Colville, WA
We're hiring in both Colville and Spokane for our Customer Service Team! As a Customer Service Specialist, you'll be the friendly, knowledgeable voice our customers rely on-whether over the phone or through other channels. You'll play a vital role in delivering exceptional service experiences that are informative, solution-focused, and genuinely human.
In this entry-level role, you'll be empowered to solve problems, answer questions, and guide individuals with empathy, professionalism, and strong technical skills. We're looking for someone who brings a deep sense of accountability and integrity to every interaction. Join our mission-driven team and start building a meaningful career in customer service, where your passion for helping others truly matters.
Service Specialists start at $19.57/hr, are bonus eligible, and we offer a highly competitive medical, dental and vision plans. We also offer an 8% 401k match, and all employees start accruing vacation and sick time from their very first day. We empower employee development through our tuition reimbursement plan, professional development plans, and employee-led communities.
At Delta Dental of Washington our vision is that all people can enjoy good oral and overall health, with no one left behind. We succeed because of a shared commitment to a set of values that guide everything we do - for our customers, for our communities, and for each other. We are Accountable. We lean in with Courage. We stay Curious. We are Inclusive. We act with Integrity.
Essential Responsibilities include the following: The list of responsibilities listed is not intended to be comprehensive. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza reserve the right to change the responsibilities at any time with or without notice.
* Successfully complete required training and maintain up-to-date knowledge of products, policies, and procedures.
* Deliver accurate, professional, and customer-focused support via phone and written correspondence.
* Resolve inquiries on the first contact whenever possible. Ensuring every customer feels heard, valued, and fully informed.
* Accurately document all interactions for tracking and analysis.
* Understand and contribute to departmental and operational goals.
* Escalate concerns appropriately and professionally.
* Manage workloads effectively by multitasking and prioritizing tasks.
* Demonstrate accountability, integrity, and professionalism in all interactions, both internally and externally.
* Embody our OneTeam Values-Accountable, Courage, Curious, Inclusive, and Integrity-in every aspect of your work.
* Perform other duties as needed.
Experience, skills, and education do you need to have to succeed in the position: The requirements listed below are representative of the knowledge, skill, and/or ability required to successfully perform the essential functions of the position.
* Clear, friendly, and professional communication skills in both verbal and written communication
* Highly detail-oriented, with strong follow-through and a commitment to delivering exceptional customer experiences
* Organized and deadline-driven, with a proven ability to manage tasks efficiently and stay on track
* Motivated and growth-minded, with a strong desire to excel and continuously develop new skills
* Comfortable navigating multiple systems and tools, with the ability to quickly learn new technologies and processes.
* Bilingual (English/Spanish) skills are preferred, but not required, to provide inclusive, accessible, and effective service to all customers.
* Authorized to work for any employer in the United States
* Ability to pass a criminal background check
* High school diploma or general education degree (GED) with customer service-related experience preferred
Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
We are committed to the highest standards of information security and HIPAA compliance, ensuring the confidentiality, integrity, and protection of all data. All staff are expected to support this commitment by following relevant policies.
$19.6 hourly 50d ago
CREATIVE DESIGNER II
Lynx 4.6
Remote or Orlando, FL job
Under general supervision of the Director of Marketing Communications and Manager of Marketing, this position is responsible for the effective design and timely production of all creatives for advertising, collateral, and other marketing materials including, but not limited to, social media, internet, intranet, campaigns, and any creative needed to convey the LYNX image and message. Provides coaching and mentoring to lower-level creative design staff members.
Essential Functions:
This list is intended to indicate the general nature and level of work performed by employees within this classification and is not designed to be interpreted as an exhaustive listing of all tasks required of employees assigned to the job. All employees will be expected to perform other duties as assigned. All jobs require regular and reliable attendance.
Designs and oversees marketing communications for bus service changes at least three times a year. Communicates with vendors and with various LYNX departments; oversees proofing process. Updates schedule books, maps, social media, signs, banners, digital slides, kiosks and website; prints and hangs in-house signage and delivers signage to other LYNX facilities; facilitates translations for LYNX collateral; laminates signs.
Develops advertising and marketing concepts to include, but not limited to, bus wraps, bus schedules/maps, flyers, posters, newsletter layouts, brochures, ads, web designs for social media, and internal and external campaigns, etc. Contributes to copy writing and develops campaign slogans.
Helps manage the marketing communications branding for the company, ensuring that all communications follow our brand guide. Oversees and updates the information that is placed on our intranet, terminal digital displays, lounge monitors, building signage, etc.
Designs art and copy layouts for social media and web applications (i.e. Facebook, X, and Instagram). Must be familiar with the various sizing requirements for each entity.
Assembles final layouts and/or prepares layouts for printer.
Publishes corporate newsletters, brochures, fact sheets and other materials as needed for individual marketing strategy.
Provides artistic and graphic support in all print advertising, campaign and miscellaneous collateral, social media concepts, television concepts, and additional duties as assigned.
Approves all layouts, photography and illustrations.
Provides graphic and artistic guidance and instruction to staff, contracted agencies and freelance artists. Participates in presentations and LYNX marketing activities. Creates slides and infographics for PowerPoint presentations.
Required Qualifications:
Bachelor's degree from a regionally or nationally accredited institution in graphic design or a related discipline plus a minimum of three years of professional working experience in the graphic design field; or an equivalent combination of related education, training, and experience.
Must have a minimum of three years of experience using Adobe Creative Suite software (Illustrator, Photoshop, and InDesign) and Microsoft Office programming on a Mac platform.
Must possess and maintain a valid Florida Driver's License and safe driving record.
Desired Qualifications:
Strong knowledge of social media.
Physical Requirements:
The physical demands described are representative of those that must be met by the employee to successfully perform the essential functions of this job.
Positions in this class typically require:
Prolonged periods sitting at a desk and working on a computer.
Close visual acuity to perform an activity such as viewing a computer terminal.
Visual acuity to determine the accuracy, neatness, color differentiation, and thoroughness of the work assigned.
Ability to stand, walk, kneel, bend, stoop, and reach.
Fine motor skills and manual dexterity.
Must be able to lift up to 15 pounds at times.
Ability to hear sounds at normal speaking levels, to receive information through oral communication and to make fine discriminations in sound.
Ability to verbally express or exchange ideas by means of spoken words.
Knowledge, Skills, and Abilities (KSAs):
Thorough knowledge of the production process and requirements.
Must be experienced taking photographs, retouching, and resizing for various elements (website, print, and various social media).
Must have conceptual knowledge of public transit planning and/or operations.
Must be able to read and draw maps.
Excellent communication and interpersonal skills.
Excellent MS Office skills (Word, Excel and PowerPoint).
Proficiency with Macintosh-based design programs to include, but not limited to, Adobe Creative Suite software.
Ability to work under pressure, prioritize tasks and handle multiple projects.
Ability to work both independently and as part of a team.
Ability to complete multiple assignments efficiently and meet established deadlines in a fast-paced team environment.
Ability to exhibit a professional, courteous demeanor.
Ability to work in a diverse environment.
Ability to establish and maintain effective working relationships with all levels of staff, the public, customers, co-workers, contracted personnel and those doing business with LYNX.
Essential Workforce Members:
LYNX provides the community with much needed public transportation, and it is important for the Agency to resume its services as quickly and as safely as possible in the event of any natural, technological, or human-caused emergency or disaster. This position is considered a mission critical member of LYNX's emergency preparation and response efforts during an emergency or disaster and as such, may be asked to work during these emergencies or disasters.
Work Environment and Special Considerations:
Works in an office environment.
May attend events outside of regular business hours.
May be required to travel to and from agency locations and other destinations.
Must be available for emergency events (i.e. working from home or on-site during hurricanes and other emergencies) to keep public informed. This will include map drawing, sign creation, getting verbiage translated, laminating signs, updating the website, social media posts, digital displays, etc.).
Sponsorship Notice: LYNX does not sponsor employment-based visas, including H-1B. All candidates must be legally authorized to work in the United States at the time of application and throughout the duration of employment.
Rate will be determined by the qualifications of candidates who exceed the minimum requirements.
Applications are reviewed as received, and interviews will be scheduled for the most qualified candidates, as applications are reviewed.
Your talent, skills and experience will be rewarded with a competitive compensation package.
FREE employee only health insurance
Dental, vision, short-term and long-term disability insurance available
Retirement plan
Life insurance
Paid vacation and sick leave
Paid holidays
FREE LYNX bus transportation for employee, spouse and children
Employee wellness center
$58k-78k yearly est. 60d+ ago
Tester, Benefit Configuration
Navitus 4.7
Remote job
Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at ************************************ to be considered for internal opportunities. Pay Range USD $20.44 - USD $24.33 /Hr. STAR Bonus % (At Risk Maximum) 0.00 - Ineligible Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am to 5pm Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview
Navitus Health Solutions is seeking a Tester, Benefit Configuration to join our team!
The Tester, Benefit Configuration ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering benefits. The primary functions of the Tester, Benefit Configuration involve performing and documenting benefit configuration testing ensuring Navitus maintains an accurate, efficient, and versatile claims adjudication system. This position develops tactical tasks and processes to incorporate client and company initiatives into testing to ensure the integrity of pharmacy claims processing.
This position may include after-hour and/or weekend hours with other eligible team members depending on workload.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
Completes scheduled and urgent benefit configuration testing of new client implementations and/or benefit additions, terminations, and changes timely and accurately to mitigate the risk of member access to care issues, missed performance guarantees and potential liquidated damages.
Acquires and maintains a basic level of understanding of Navitus' claims adjudication system and upstream/downstream processes to test both standard and custom configurations to meet client expectations.
Uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
Complies with standards set forth regarding benefit design and configuration testing including HIPAA, NCPDP and Navitus internal business standards.
Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to general customer questions and issue resolution requests.
Supports internal customers by participating in client meetings, audits, and new program implementations with other areas of the company, answering benefit testing questions and providing guidance to other areas and roles on the benefit configuration testing process.
Adapts to industry changes and evolving technology, maintaining a basic level of understanding of both legacy and emerging products and systems.
Independently assesses business needs and participates in process improvement, cost reduction and automation efforts.
Contributes to the creation and ongoing maintenance of departmental training materials, work instructions and policies.
Conducts system enhancement and regression testing of a low to moderate level of complexity for benefit configuration processes to ensure compliance with state, federal and client regulations/standards.
Contributes to training and maintains a mentoring relationship with new and existing benefit configuration testing team members.
Other duties as assigned.
Qualifications
What our team expects from you?
Associate's degree or equivalent work experience required.
Minimal experience and/or training to begin learning skills, systems, and processes of the role with ability to perform tasks with close supervision.
Experience on basics and gaining familiarity with the role and company.
Basic experience with Microsoft Office, specifically Word and Excel.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.
What can you expect from Navitus?
Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program - up to $750!
#LI-Remote
Location : Address Remote Location : Country US
Founded in 2011, World is one of the fastest-growing insurance brokers in the U.S. with over 2,200 employees in over 210 offices across North America. We specialize in personal and commercial insurance lines, surety and bonding, employee benefits, financial and retirement services, and human capital management solutions.
At World Insurance, you'll be part of a collaborative team dedicated to delivering best-in-class financial and analytical support to employee benefits clients. This role offers the opportunity to deepen your expertise in underwriting and analytics and grow within the practice while playing a key role in helping employers make smarter benefits decisions.
Position Overview
World Insurance is seeking an experienced Employee Benefits Underwriting & Financial Analyst to join our Underwriting & Analytics team. In this role, you will analyze financial and contractual information for current and prospective clients ranging from fully insured to self-funded arrangements. You'll prepare financial deliverables, model renewals, evaluate utilization trends, and support client decision-making with data-driven insights. You'll work closely within a team of underwriters & financial analysts, while also collaborating with our service teams to deliver high-quality support to clients.
Key Responsibilities
Manage and prioritize analytical workflow to ensure accurate, timely deliverables.
Prepare and maintain financial dashboards for a book of business (clients typically 100-500 employees). Client funding arrangements may range from fully insured, level funded, and self-funded.
Conduct standard client analyses in alignment with the service calendar, including:
Market review analysis
Renewal rate and funding initial projections/modeling
Claims utilization review
Rate and contribution modeling
Benchmarking studies
Self-funded feasibility analysis
Technical review of group insurance contracts and financial arrangements
Follow established procedures to utilize systems such as BenefitPoint, PerfectQuote, and others.
Collaborate with subject matter experts, including Population Health Management, to deliver holistic client solutions.
Develop alternative plan strategies, models, and cost-reduction opportunities using analytical tools and templates.
Act as primary contact with carriers for marketing, quoting, and renewals; request, evaluate, and negotiate proposals.
Build and maintain excellent relationships with carrier partners.
Draft client-facing executive summaries, including findings, observations, and recommendations.
Prepare formal correspondence such as carrier renewal confirmations and client renewal letters.
Participate in the peer review process to ensure accuracy and quality.
Provide prospect and ad hoc analytical support as needed.
Perform other duties as assigned.
Qualifications
2-3+ years of experience in employee benefits, insurance, or a related field.
College degree or CEBS designation preferred.
Life & Health insurance license, or willingness to obtain within 90 days of hire.
Ability to work in a fast-paced environment with some oversight and a high degree of accuracy and attention to detail.
Advanced proficiency in Microsoft Excel (formulas, modeling, formatting) with strong skills in Word and other MS Office tools such as Power BI.
Understanding and/or prior use of Claros, Blue Raven, or other actuarial modeling tools is ideal.
Technical experience with BenefitPoint, AI, Benefit Administration Systems, and Carrier Portals is preferred.
Strong analytical, problem-solving, and critical thinking abilities, with the ability to work with complex data and variables.
Excellent written, oral, and interpersonal communication skills.
Team-oriented, client-focused, and able to build effective working relationships with colleagues, carriers, and clients.
Commitment to staying current on industry trends, regulations, and emerging products.
Compensation:
This is a remote position. The base salary at the time of this posting may range from $80,000-$90,000. Individual compensation varies based on job-related factors, including business needs, experience, level of responsibility, and qualifications. We offer a competitive benefits package and variable pay programs, please visit ************************************** for more details.
Equal Employment Opportunity
At World Insurance Associates (WIA), we celebrate and support our differences. We know employing a team rich in diverse thoughts, experiences, and opinions allows our employees, our products, and our community to flourish. WIA is honored to be an equal opportunity workplace. We are dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, WIA makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of our business.
To Executive Search Firms and Staffing Agencies:
World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Human Resources Talent Department.
#LI-MA1
#LI-REMOTE
$80k-90k yearly Auto-Apply 21d ago
Intake Specialist I
Navitus Health Solutions 4.7
Remote job
Company Lumicera About Us Pay Range USD $20.00 - USD $21.96 /Hr. STAR Bonus % (At Risk Maximum) 0.00 - Ineligible Work Schedule Description (e.g. M-F 8am to 5pm) 6am CST to 7pm, CDT Remote Work Notification ATTENTION: Lumicera is unable to offer remote work to residents of Alaska, Connecticut, Delaware, Hawaii, Kansas, Kentucky, Maine, Massachusetts, Mississippi, Montana, Nebraska, New Hampshire, New Mexico, North Dakota,Rhode Island, South Carolina, South Dakota, Vermont, West Virginia, and Wyoming. Overview
Due to growth we are adding an Intake Specialist to our team!
Under direction from the Assoc. Manager, Patient Support Services and pharmacists in the Specialty Pharmacy, the Intake Specialist I is primarily responsible for enrolling new Specialty Pharmacy patients and ensuring that all pertinent patient information is contained within the record. Patient information shall include demographics, allergies, medication history, comorbidities, and payer information. The Intake Specialist I's main objective is to place phone calls to new and existing patients, answer phone calls and contact the doctors and patients via fax or phone or other communication means. The Intake Specialist I is also responsible for accurately translating prescription information and all other information obtained to dispense the medication into the pharmacy dispensing software. The Intake Specialist I may also be responsible for obtaining information and assisting providers and insurance companies in triaging prior authorizations for patients of the specialty pharmacy. The Specialty Pharmacist is accountable for verifying the prescription entry. This position will function with and assist any other area in the facility as needed regarding pharmacy technician type duties.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
Responsible for placing phone calls to new and existing Specialty Pharmacy patients
Responsible for enrolling patients into specialty services which may include, patient care management, copay assistance programs, and billing information
Responsible for answering the inbound calls from patients, prescribers, and other healthcare professionals
Responsible for contacting doctors to obtain necessary information
Responsible for managing the assigned workflow queues
Responsible for accurate and thorough documentation of information and prescription order set up
The Employee will act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve. Thus, legal and ethical compliance is an essential duty of each employee
Other duties as assigned
Qualifications
What our team expects from you?
High school diploma or GED
Some college preferred
National CPhT and/or registration/licensure required per employee's residing state's requirements
Minimum two years pharmacy support experience or healthcare environment experience preferred
Ability to work scheduled hours, shifts may vary based on department needs. Hours of operation are 8am to 7pm Monday thru Thursday and 8am to 6pm on Friday
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Lumicera?
• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
#LI-Remote
Location : Address Remote Location : Country US
$20-22 hourly Auto-Apply 60d+ ago
Supervisor, Claim Adjudication Operations
Navitus 4.7
Remote job
Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at ************************************ to be considered for internal opportunities. Pay Range USD $61,968.00 - USD $74,660.00 /Yr. STAR Bonus % (At Risk Maximum) 7.50 - Pharm, Supvr, AsMgr, SrCSEII, PrgMgr, SrPrgMgr, SrProdMgr Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am to 5pm Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview
Navitus Health Solutions is seeking a Supervisor, Claim Adjudication Operations to join our team!
The Supervisor, Claim Adjudication Operations (CAO) ensures efforts are in alignment with the CAO team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members and pharmacies by accurately administering benefits. This role will plan, design, coordinate and align resources to support the daily activities of the team. The Supervisor, CAO role will work closely with their team to identify, recommend, develop, implement, support, and improve customer-focused solutions.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
Oversee roles within the Claim Adjudication Operations department to support accurate and timely configuration and data transfers of client hierarchy, benefits, and networks.
Provide superior customer service utilizing a high-touch, customer centric approach focused on collaboration and communication.
Outreach and collaborate with CAO customers/partners for day-to-day work and contribute to action plan creation.
Oversight of work on Kanban boards, meeting turnaround times and performance guarantees.
Run department Kanban board(s) and huddles, including sizing of work requests.
Resource assignment of day-to-day work, audits, and root cause analysis/CAP.
Perform 1:1s to elicit feedback from department associates, provide mentorship, discuss career development, address performance, and provide workload and project guidance.
Perform workforce management duties for direct reports, including, but not limited to, overtime needs, time out of the office and time tracking.
Apply soft skills toward team members and external stakeholders alike in understanding every point of view and coming to the table with good negotiation skills. Must have the ability to work with different personalities across all departments and understand their point of view to communicate accordingly.
Adhere to department level objectives to ensure alignment with division and company strategic initiatives.
Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
Other duties as assigned.
Qualifications
What our team expects from you?
Bachelor's degree or equivalent work experience is required.
4 years of experience required.
Knowledge of one or more responsibilities as defined above is strongly preferred.
Professional PBM industry work experience is preferred.
Knowledge of applicable data privacy practices and laws is preferred.
Healthcare industry practices and HIPAA knowledge would be a plus.
Experience as a member of a multi-disciplinary team is a plus.
Understanding of human resource management principles, practices, and procedures would be a plus.
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program - up to $750!
#LI-Remote
Location : Address Remote Location : Country US
$62k-74.7k yearly Auto-Apply 43d ago
Director of Finance, Financial Services
World Insurance Associates 4.0
Remote or Santa Barbara, CA job
Objective World Investment Advisors is currently seeking a Director of Finance to provide strategic financial leadership and oversight to drive the financial health and performance of the organization. The Director of Finance will be responsible for developing and implementing financial strategies, managing budgeting and forecasting processes, ensuring compliance with regulatory standards, and delivering data-driven insights to support executive decision-making. This role will play a key part in optimizing capital structure, enhancing profitability, and supporting sustainable growth within the dynamic landscape of the financial services industry.
Typical Duties and Responsibilities
Creating forecasts that get updated on a regular basis (e.g., each month or maybe 1x/quarter).
Running point on creating the budget each year
Building the templates and/or implementing the tools to obtain input from unit leaders, department heads, etc.
Loading the data into NetSuite once the budget is complete
Meeting with unit leaders and/or department heads to review their budgets
Provide detailed analysis/write-up on budget vs. actual each month
Review reported results vs. budget to identify variances
Meet with unit leaders and/or department heads to review variances (both positive and negative)
Identify opportunities to either grow revenue or improve margins
Prepare board materials to support Renae/Troy when they meet with the board
Work with accounting to identify ways to improve analytical reporting capabilities
E.g., review results with Controller to identify any data anomalies
Work with colleagues to transition new acquisitions into “standard FPA process” for forecasting and reviewing budget vs. actual
Identify data sources that we can leverage to improve analytical capabilities
Support Accounting team with miscellaneous projects
Participate in the M&A process to help evaluate acquisition targets
Position Requirements
A Bachelor's degree in accounting, or a Bachelor's degree in business with emphasis in accounting, is required.
Degree(s) must be from a credible college or university
Excellent technology and communication skills
Ability to work independently to manage time and prioritize tasks efficiently.
Be a motivated self-starter who can make thoughtful, deliberate decisions with minimal assistance.
The desire to be an enthusiastic, cooperative team player who is always seeking ways to improve processes.
Compensation
The salary for this position generally ranges between $170,000-$180,000. This range is an estimate, based on candidate qualifications and operational needs. The position will also be eligible for up to a 15% annual bonus.
Perks & Benefits
401(k) with Employer Match
Health Insurance (with HSA option)
Dental Insurance
Vision Insurance
Life Insurance
Flexible Paid Time Off Policy
Flexible Spending Account (FSA)
Healthy Work/Life Balance
Maternity/Paternity Leave Policy
Remote Work Opportunity
About World Investment Advisors
As part of World Insurance Associates, World Investment Advisors is a nationally recognized financial services firm dedicated to providing the industry's premier wealth management and retirement plan investment advisory services to individuals, high net worth families and employers. Collectively, WIA and its affiliates advise pm $76B assets
1
across 65 offices and 310 team members.
Stimulating Environment
At World Investment Advisors, we strive to provide a challenging, stimulating environment for the best and brightest in the industry. We believe our employees can best serve our clients and advisors in an atmosphere where individuals are treated fairly, where professional growth is fostered and encouraged, and where a healthy balance between work and home life is respected and preserved. We promote a friendly and collaborative work environment. We are motivated by team camaraderie and are obsessed with doing the right thing for our plan sponsor clients and their plan participants.
Team-Oriented
Professionals typically work together in teams with multiple people from different departments to meet our clients' needs. Our junior staff works with their team members to develop the skills and knowledge to succeed and assume more senior level positions as they progress at our firm. We welcome team members from different backgrounds with different perspectives to help us innovate and make a difference for our customers and our communities.
Why World?
Great company culture with an awesome team-oriented atmosphere!
Mentorship Opportunities
Ability to serve on different internal steering committees (Charitable Giving, DEI, Social, etc.)
Professional growth opportunities
Friendly and collaborative work environment
Employee perks including fun team building opportunities, yoga/wellness, charitable giving/volunteering
World Investment Advisors is an equal opportunity employer. We believe the most effective way to attract, develop and retain a diverse workforce is to build an enduring culture of inclusion and belonging. World is committed to equality and deeply believes in diversity in sexual orientation, gender, race, religion, ethnicity and other qualities that makes us all different.
1
As of December 31, 2023, the WIA network of advisors and firms collectively provides support to over $55.4 billion in assets across a variety of channels including investment management and retirement plan consulting services. This includes regulatory assets under management (AUM) of over $24.5 billion
TO EXECUTIVE SEARCH FIRMS AND STAFFING AGENCIES:
World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Human Resources Talent Department.
$170k-180k yearly Auto-Apply 60d+ ago
Expert (Staff) Vulnerability Management Engineer
Delta Dental 4.9
Remote Delta Dental job
does not offer work visa sponsorship*
We are seeking an Expert (Staff) Vulnerability Management Engineer to join our Enterprise Vulnerability Management team. This role is responsible for planning, developing, and implementing enterprise-scale vulnerability management solutions to meet current and emerging security needs. You will proactively identify and resolve complex information security challenges, while designing, implementing, and maintaining a world-class vulnerability management program. Key focus areas include strategic planning, capability assessment, process development and refinement, technology capability analysis, and the implementation and continuous improvement of process support tools.
7+ years of professional experience in Cybersecurity domain with a Bachelor's degree in Computer Science, Information Security, or a related field; an equivalent combination of education and experience will also be considered.
8+ years of combined hands-on cybersecurity and vulnerability management development and implementation work. Experience with a broad exposure to cloud, infrastructure, network, and multi-platform environments.
2+ years of hands-on experience assessing vulnerabilities and using contextual risk to prioritize remediation efforts.
2+ years of experience in responding to zero-day and high-profile vulnerabilities.
2+ years of experience in cybersecurity solution engineering or security service delivery.
2+ years of leadership experience with planning and managing cybersecurity implementations and/or leading a team of technical resources. This role will require the management of several (2 to 4) concurrent large-scale vulnerability management capability development projects.
Industry certifications such as CISSP, GSEC, OSCP, or comparable security-related credentials are strongly preferred.
Knowledge, Skills, Abilities
Required:
A strong, complete, and working understanding of Microsoft Azure cloud and foundational cloud concepts.
A robust understanding of contemporary security theory and application, including the vulnerability lifecycle, scanning methodologies (SAST, DAST, IAST, RASP), exploitation techniques, and attack vectors.
Strong understanding of systems development lifecycle to lead multifunctional projects or initiatives.
A robust understanding of vulnerability scoring systems (CVSS), security benchmarks (CIS, NIST), and risk quantification techniques.
Excellent written and verbal communication skills (including technical writing).
Excellent communication and presentation skills, with the ability to convey technical concepts to diverse audiences and a strong emphasis on listening and understanding stakeholder needs.
Ability to develop executive communications and interact with senior leadership.
Strong ability to build trust, partnerships, and mutual support across many diverse teams.
Strong strategic planning, maturity assessment, analytical and problem-solving skills; ability to examine issues both strategically and analytically.
Adaptive and demonstrated ability to learn quickly.
Ability to interact well with co-workers and outside contacts.
Ability to work collaboratively in a team environment.
Ability to work on multiple, simultaneous initiatives and prioritize workload to meet commitments.
Self-motivated with a strong sense of urgency.
History of and commitment to ethical behavior.
Preferred:
A strong, complete, and working understanding of key programming languages and frameworks (e.g., Java, Python, JSP, PHP, Node.js, etc.)
A strong understanding of cyber threat intelligence competencies (cyber kill chain, diamond model, TTPs).
Foundational knowledge of data analytics and visualization tools (e.g., Splunk, Tableau).
Knowledge of laws, regulations, and standards relevant to the US Healthcare industry.
Base Pay Information
The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.
Pay Grade 25. $140,700 - $305,000
Vulnerability Management Strategic Planning, Design & Implementation:
Performs vulnerability management capability assessments, process development and refinement activities, technology capability assessments, and solution design and implementation projects that ensure the security of the enterprise environment.
Leads strategic planning activities informed by capability assessments which holistically address current and future maturity states of vulnerability management capabilities. Builds strong narratives to drive decision-making and educates leadership stakeholders on proposed plans.
Serves as a security expert in vulnerability management solutioning, including vulnerability identification, assessment, and validation for CI/CD pipelines, cloud environments, and infrastructure.
Engages with enterprise architects, security specialists, technology engineers, and other functional area specialists to ensure that enterprise technologies and security solutions are correctly configured and deployed to sufficiently mitigate identified risks and meet requirements for the enterprise, customers, partners, and vendors.
Exercises thought leadership in the creation and maintenance of vulnerability management capabilities, processes, procedures, technologies, and technical capability requirements.
Vulnerability Management Operations:
Creates and maintains a view of IT assets, related attack surfaces, and emerging vulnerabilities to illustrate the flow of data and associated security threats.
Manages the entire lifecycle of vulnerabilities from discovery, triage, advising, remediation, and validation.
Serves as a cybersecurity subject matter expert, assessing the business impact of cybersecurity risks to the enterprise and identifying options and recommendations for mitigating those risks.
Serves as an expert in platform, application, storage, network, virtualization, cloud, and mobile security best practices.
Develops leadership-level communications, including board of director and executive metrics, business cases, standards, policies, procedures, architecture design documents, etc.
Collaboration:
Communicates and interacts effectively with leadership, management, co‑workers, internal and external customers, and partners. Communicates strategic planning narratives and design, as well as implementation plans, to both technical and non‑technical audiences.
Focuses on building stakeholder partnerships and offers support to other contributors within the Technology Org.
Contributes to team culture by modeling integrity, inclusivity, accountability, and collaboration.
Educates, coaches, and mentors junior team members and expands the team's overall skill sets.
$80k-113k yearly est. Auto-Apply 13d ago
Pharmacist, Clinical Consultation
Navitus Health Solutions 4.7
Remote job
Company Lumicera About Us Pay Range USD $110,000.00 - USD $122,980.00 /Yr. STAR Bonus % (At Risk Maximum) 7.50 - Pharm, Supvr, AsMgr, SrCSEII, PrgMgr, SrPrgMgr, SrProdMgr Work Schedule Description (e.g. M-F 8am to 5pm) 10:30am-7pm M-Th, 9:30am-6pm F in CT Remote Work Notification ATTENTION: Lumicera is unable to offer remote work to residents of Alaska, Connecticut, Delaware, Hawaii, Kansas, Kentucky, Maine, Massachusetts, Mississippi, Montana, Nebraska, New Hampshire, New Mexico, North Dakota,Rhode Island, South Carolina, South Dakota, Vermont, West Virginia, and Wyoming. Overview
Due to growth, we are adding a Pharmacist, Clinical Consultation to our Specialty Pharmacy Clinical Services department.
The main duty of the Pharmacist, Clinical Consultation is to perform telephonic consultations with patients regarding the use of their specialty medication and management of their disease state. The Pharmacist, Clinical Consultation will perform medication reconciliation, screen for potential drug interactions, and provide side effect management recommendations. Additional tasks for this role include interpreting physicians' prescriptions, contacting prescribers for prescription clarification, and expediting the processing of orders. The individual in this position will be expected to meet department production metrics and service levels, support quality standards, resolve patient issues, and vary work priorities and activities to accommodate business needs. The Pharmacist, Clinical Consultation works independently with minimal guidance and represents the organization using patient-centered care to enhance the patient experience.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
Provide patient education through telephonic consultations for patients of the specialty pharmacy in accordance with Lumicera's Patient Management Program. The consultations will focus on effective assessment and communication of disease state management, side effect mitigation strategies, administration of medication, appropriate storage, and therapeutic appropriateness, following patient-centered care model. Answer clinical questions from patients and caregivers.
Provide detailed clinical documentation of patient consultations and interventions in pharmacy software system in compliance with internal policies and procedures and external regulatory bodies (such as URAC).
Interpret and clinically evaluate prescriptions for specialty medications based on available information and resources. Contact providers and/or patients to verify information related to prescriptions such as drug strength, intended directions, and diagnosis to expedite processing of orders. Verify and confirm validity of controlled substances.
Contact physicians for new prescriptions, consult with physicians and nurses regarding pharmaceutical questions, and contact pharmacies for prescription transfers. Work with physicians to convert prescriptions to generic, biosimilar, or preferred drugs whenever possible.
Verify prescription information entered in the system by order entry. Answer clinical questions from the pharmacy team.
Adapt to new workflows and processes. Solve unique pharmaceutical problems. Stay current with advancements in specialty pharmacy therapies, including new drug approvals and specialty disease state treatment guidelines.
Back up other pharmacists as needed; train less experienced pharmacists.
Document and report medication errors per company policies and procedures. Facilitate error reduction and prevention methods based off quality department and ISMP standards.
Act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve.
Other duties as assigned
Qualifications
What our team expects from you?
Graduate of an ACPE Accredited School of Pharmacy with a B.S. Pharmacy or PharmD degree.
Current, unrestricted pharmacist license in state of residence; must continually obtain education credits to maintain active licensure.
At least two years of experience as a practicing licensed Pharmacist preferred.
Strong clinical background .
Experience and/or strong understanding of Specialty Pharmacy medications desirable.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.
What can you expect from Lumicera?
Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program - up to $750!
#LI-Remote
Location : Address Remote Location : Country US
$110k yearly Auto-Apply 60d+ ago
Sr. Content Editor
Navitus 4.7
Remote job
Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at ************************************ to be considered for internal opportunities. Pay Range USD $69,627.00 - USD $83,888.00 /Yr. STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am to 5pm Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview
Due to growth, we are adding a Senior Content Editor to join our team!
The Senior Content Editor role designs and owns the architecture for the overall proposal content knowledgebase used to support the client acquisition and retention efforts of Navitus Health Solutions (Navitus). This position works cross-functionally at a variety of levels to craft, maintain and expand digital content while improving proposal quality and team productivity. The Senior Content Editor ensures regular reviews of the knowledgebase and data integrity. Requires the ability to take complex concepts and translate them into a defined style that clearly and accurately articulates Navitus' value proposition. This position requires strong communication skills and a high proficiency with content data libraries and document automation software.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
Seek and build best-in-class content that easily integrates into proposals and other sales related documents for various markets (e.g. health plans, government, national accounts, mid-market employers).
Oversee the accuracy, organization and formatting of library content to keep the proposal knowledgebase current, competitive and usable by the proposal team.
Collaborate with Subject Matter Experts (SMEs) to convert complex and varying explanations into concise and compelling value propositions and proof points consistent with Navitus' brand/style guide and sales strategy.
Identify gaps in the knowledgebase and ensure timely updates of all content positioning and related exhibits through regular content audit reviews.
Work collaboratively with those contributing to and/or drawing from the knowledgebase, such as proposal team members, executives, management teams, business units, partners, and SMEs.
Serve as a proposal content knowledgebase expert by communicating important updates related to processes, messaging and content management, including SME list management, training and alignment.
Serve as a proposal automation software expert to all users in the company. This includes adding new users to the system, providing new user training materials and providing subsequent navigation assistance as needed.
Maintain a high level of proficiency with the knowledgebase system and apply new functionality to improve how content is organized, updated and accessed.
Contribute to the department goal of improved efficiency and effectiveness by implementing processes to streamline proactive creation.
Consult system reporting and analytics to gain insights into content preparation and usage to inform training opportunities and improvement efforts.
Other duties as assigned
Qualifications
What our team expects from you?
A minimum of a bachelor's degree, preferably in English, Journalism or a Communications-related field, or equivalent related experience required.
Minimum of four years of experience writing and managing content. Experience with proposals in the pharmacy benefit management or health insurance industry is preferred.
Demonstrated experience supporting a proposal knowledgebase and related processes.
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program - up to $750!
#LI-Remote
Location : Address Remote Location : Country US
$69.6k-83.9k yearly Auto-Apply 56d ago
Operations Training Specialist
Delta Dental Washington Dental Service 4.9
Delta Dental Washington Dental Service job in Spokane, WA
Ready to make an impact? Our Training team is looking for someone like you! The Training Specialist I plays a key role in supporting the Operations team by training new employees, managing learning programs, and monitoring ongoing learning and development throughout Customer Service and Claims Processing. This role also involves facilitating group transitions, implementing process improvements, standardizing policies and procedures, collaborating across departments, researching issues and trends, delivering daily communications, and updating process documentation.
At Delta Dental of Washington our vision is that all people can enjoy good oral and overall health, with no one left behind. We succeed because of a shared commitment to a set of values that guide everything we do - for our customers, for our communities, and for each other. We are Accountable. We lean in with Courage. We stay Curious. We are Inclusive. We act with Integrity.
We offer a highly competitive medical, dental and vision plans as well offering a generous 401k match and all employees start accruing vacation and sick time from their very first day. We empower employee development through our tuition reimbursement plan, professional development plans, and employee-led communities.
The pay range for this position In Western Washington varies between $40,905.00 - $55,298.00, and for Eastern Washington varies between $40,560.00 - $54,416.00. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza intends to offer the selected candidate a base pay within this range, dependent on job-related, non-discriminatory factors such as experience. Base pay will also be adjusted based on the candidate's geographic location.
Essential Responsibilities include the following: The list of responsibilities listed is not intended to be comprehensive. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza reserve the right to change the responsibilities at any time with or without notice.
* Implement, facilitate, and monitor new and existing employee training programs.
* Plan, prepare, and manage training sessions for smooth execution and timely delivery.
* Lead and facilitate both classroom and virtual training sessions, ensuring engagement and comprehension across all levels.
* Provide feedback on employee progress and adjust training methods as necessary.
* Regularly update training plans, facilitator documents, and learner-facing materials for accuracy and relevance.
* Manage the Operations Trainers inbox, tracking and responding to training inquiries.
* Review and provide feedback on learning materials and communications created by team members.
* Maintain the documentation repository for claims processing and customer service to support training efforts.
* Collaborate with the Training Specialist II and Documentation and Training Specialist to design, maintain, and update training curricula and course materials.
* Serve as a backup for the Operations Documentation Specialist and Group Administration Training and Documentation Specialist as needed.
* Work with departments and leadership to plan, organize, and implement interdepartmental changes and process standardization.
* Develop and execute communication and documentation plans for process changes, system updates, and new initiatives.
* Recommend ideas for continuous process improvement, ensuring training aligns with operational needs.
* Provide recommendations and support to Operations leadership on employee development and training initiatives.
The experience, skills, and education needed to succeed in the position are outlined below. These requirements are representative of the knowledge, skills, and abilities required to successfully perform the essential functions of the role.
* Strong communication skills, with the ability to present clearly in both classroom and virtual settings.
* Comfortable providing and receiving constructive feedback for personal and professional growth.
* Ability to engage with diverse groups and ensure understanding across all staff levels.
* Excellent organizational skills to plan, prepare, and manage training sessions effectively.
* Adaptable in adjusting training methods based on employee progress and feedback.
* Collaborative mindset to work with departments and leadership on process improvements and interdepartmental changes.
* High attention to detail in maintaining accurate training plans, documentation, and materials.
* Efficient in managing multiple tasks, including inbox inquiries and documentation maintenance.
* Proactive in identifying opportunities for continuous improvement in training and operational processes.
* Willingness to travel to other sites in Washington State as needed.
* Ability to utilize systems and tools supporting contact center, claims, provider relations, and group administration (previous experience preferred).
* Two years of experience in Operations, Provider Relations, or healthcare/insurance-related fields; or one year of training experience, or equivalent education and experience.
Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
We are committed to the highest standards of information security and HIPAA compliance, ensuring the confidentiality, integrity, and protection of all data. All staff are expected to support this commitment by following relevant policies.
$40.9k-55.3k yearly 13d ago
Business Intelligence Developer
Navitus 4.7
Remote job
Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at ************************************ to be considered for internal opportunities. Pay Range USD $72,813.00 - USD $89,341.00 /Yr. STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am-5pm, CT Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview
Navitus Health Solutions is seeking a Business Intelligence Developer to join our team!
The Business Intelligence Developer brings together theory and practice to identify and communicate data-driven insights that allow managers, stakeholders, and other executives in the organization to make informed decisions. The Business Intelligence Developer will have an intermediate understanding of the company's databases, business intelligence (BI) tools, and existing reports and act as a resource in internal and external meetings. A good candidate will be detail oriented, analytical, a skilled communicator, and a quick learner with experience in analytics, data modeling, or business intelligence.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
Use Qlikview, QlikSense, SQL Server Management Studio, Oracle SQL Developer, and other tools to prepare data visualizations and ad hoc reports
Develop reporting application scripts that import data from various sources
Identify inter-departmental dependencies and downstream impacts of changes within reporting applications
Communicate effectively and work closely with a variety of users to gather requirements, present solutions, validate effectiveness, and conduct user testing
Adapt quickly to changing reporting requirements and new BI tools in a rapidly evolving, high-growth organization
Facilitate in ongoing data validation to ensure data integrity and reliability
Verify analysis, reports or other deliverables are complete and accurate
Assist users on how to extract the information from the BI tools
Identify and provide insights into streamlining analytics processes and research improvement opportunities
Other duties as assigned
Qualifications
What our team expects from you?
BA/BS with focus on business, computer science, information systems, mathematics, statistics or equivalent combined education and experience preferred
At least one year of experience in analytics, data modeling, or business intelligence is preferred
Experience with BI tools such as Tableau, Qlikview/QlikSense, SAS, Power B.I. or other Business Intelligence software and/or data visualization programs is required
Knowledge with additional data analytic tools such as SQL, Python or R is preferred
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program - up to $750!
#LI-Remote
Location : Address Remote Location : Country US
$72.8k-89.3k yearly Auto-Apply 38d ago
Regulatory Manager
Delta Dental Washington Dental Service 4.9
Delta Dental Washington Dental Service job in Seattle, WA
Are you passionate about navigating the complexities of regulatory compliance and excited by the opportunity to lead regulatory components of our standard portfolio of products, and regulatory processes for individual and group dental and ancillary products? In this role, you will manage our product and portfolio templates including oversight of their regulatory filings, Appeals, Complaints, and related operational projects. You will drive process improvements and lead a team to ensure accurate, timely, and compliant filings with the OIC, along with effective Appeals and Complaints resolution within established deadlines. Additionally, you'll support the business in regulatory matters and ensure that filings and processes meet compliance standards and business needs.
At Delta Dental of Washington our vision is that all people can enjoy good oral and overall health, with no one left behind. We succeed because of a shared commitment to a set of values that guide everything we do - for our customers, for our communities, and for each other. We are Accountable. We lean in with Courage. We stay Curious. We are Inclusive. We act with Integrity.
We offer a highly competitive medical, dental and vision plans as well offering a generous 401k match and all employees start accruing vacation and sick time from their very first day. We empower employee development through our tuition reimbursement plan, professional development plans, and employee-led communities.
The pay range for this position in Western Washington varies between $81,900 - $116,550, and for Eastern Washington varies between $71,411 - $101,623. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza intends to offer the selected candidate a base pay within this range, dependent on job-related, non-discriminatory factors such as experience. Base pay will also be adjusted based on the candidate's geographic location.
Essential Responsibilities include the following: The list of responsibilities listed is not intended to be comprehensive. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza reserve the right to change the responsibilities at any time with or without notice.
Leadership
* Build, mentor, and develop a dedicated team by providing strategic direction and opportunities for employee development, fostering teamwork, and accountability.
* Collaborate cross-functionally to understand needs and support departmental and corporate projects that improve efficiency, accuracy, and overall effectiveness.
* Represent department in project discussions, and cross-functional work groups, contributing insights to enhance organizational compliance, efficiency, and responsiveness.
* Collaborate with the Director of Regulatory Operations to assess and address staffing requirements, ensuring alignment with operational goals and strategic priorities.
* Build and maintain strong relationships with internal and external partners and regulators on regulatory, and compliance matters.
Regulatory Oversight
* Act as the primary liaison with regulatory agencies, managing complex inquiries, engaging proactively, and advocating for favorable outcomes.
* Lead strategic oversight of standard portfolio filings with the Office of the Insurance Commissioner (OIC), ensuring alignment with evolving regulatory guidelines and proactively addressing compliance risks.
* Engage proactively with legal counsel to navigate complex regulatory and compliance issues, driving strategic alignment with legal requirements, mitigating organizational risk, and supporting key business initiatives with informed, high-impact decision-making.
* Collaborate with cross-functional teams (e.g., Product, Sales, Legal, and Operations) to integrate regulatory requirements into product design, ensuring compliance from ideation through launch.
* Conduct thorough research to identify, interpret, and stay current with relevant regulatory requirements, policies, and industry standards.
* Analyze complex regulatory information to assess impacts on organizational operations, projects, or decisions.
* Develop and implement regulatory policies and strategies to ensure timely and appropriate filings, clear and appropriate communication with members, regulatory agencies, and internal stakeholders, and compliance with regulations to mitigate risk.
* Partner across the organization to align regulatory processes with broader business goals, ensuring consistency and strategic integration across departments. Act as a liaison for regulatory communications with DDWA stakeholders, plan administrators, and vendors.
* Implement and maintain standardized process for documentation, compliance tracking, and Appeals and Complaint management.
* Establish procedures for documentation and version control of regulatory files, correspondence with outside regulators, vendors, and internal partners.
* Lead the regulatory oversight of the DeltaCare products, participate in and manage contractual components of annual code updates, compensation filings/changes, and exception requests from internal stakeholders to ensure alignment with regulatory standards and business objectives.
* Oversee special filing types such as our Health Care Benefit Manager and leased network filings, ensuring timely, accurate submissions and compliance with regulatory requirements.
Operational Efficiency
* Collaborate with Regulatory, Compliance, and Contracts leadership team to identify inefficiencies in current processes, build, document, and implement improvements.
* Manage the companywide Contract Language Workgroup (KLAW) workgroup and develop standardized template/product development and filing processes, ensuring coordination, compliance, efficiency, and implementation success across departments.
* Manage the process for reviewing, resolving, and approving exception requests to policies or procedures from HCBMs, plan administrators, vendors, and internal stakeholders, escalating as needed and ensuring clear communication, accurate documentation, and compliance with requirements.
* Monitor federal, state, and local regulations and partner with Leadership, Legal and Government Affairs to identify emerging risks, assessing potential impacts on business operations and developing mitigation strategies.
* Establish performance metrics and reporting structures to monitor team performance, and compliance trends, translating insights into actionable strategies.
* Oversee SERFF user management and permissions, as well as vendor billing and invoicing, ensuring compliance with regulatory and company standards.
The experience, skills, and education needed to succeed in the position are outlined below. These requirements are representative of the knowledge, skills, and abilities required to successfully perform the essential functions of the role.
* 5+ years of experience in a regulatory or compliance-based role within a regulated industry, such as healthcare, insurance, or finance.
* Experience building and leading regulatory, contracts, or compliance teams.
* Project management experience, particularly in implementing and optimizing regulatory systems, workflows, and processes.
* Excellent communication and interpersonal skills, collaborate effectively and influence at all levels of the organization.
* Solid understanding of regulatory and compliance requirements relevant to the industry (e.g., OIC regulations, contracting standards, etc. ).
* Proven ability to listen, understand, and analyze complex regulatory issues, taking appropriate action when necessary.
* Strong proficiency with business software platforms and document management systems.
* Demonstrates integrity in all actions, consistently upholding ethical standards even in challenging situations, and skillfully navigating sensitive or difficult conversations with respect and professionalism.
* Ability to assess regulatory risk and provide guidance to mitigate these risks.
* Familiarity with Salesforce and Dental on Demand preferred.
Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
We are committed to the highest standards of information security and HIPAA compliance, ensuring the confidentiality, integrity, and protection of all data. All staff are expected to support this commitment by following relevant policies.
$81.9k-116.6k yearly 9d ago
Clinical Intern - Pharmacy
Navitus 4.7
Remote job
Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at ************************************ to be considered for internal opportunities. Pay Range USD $17.78 - USD $20.91 /Hr. STAR Bonus % (At Risk Maximum) 0.00 - Ineligible Work Schedule Description (e.g. M-F 8am to 5pm) M-Th between 8:30am to 7pm and F 8:30am-5pm Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview Navitus Health Solutions is seeking a Clinical Intern to join our team! The Clinical Intern will be a key contributor to the success of our Clinical Engagement Center focused on improving member's health and wellness via tele-pharmacy and wellness coaching. Under the supervision of a clinician, this individual is responsible for the delivery of the Medication Therapy Management (MTM) services for commercial and Medicare members. In addition, the Clinical Intern will assist in the development and execution of additional clinical outreach programs to exceed client expectations. The MTM program will include telephonic and/or video chat outreach with members to complete an analysis of a member's medication regimen for prescription, OTC, herbal and supplement medications. The assessment will include the development of a personalized Medication Action Plan in partnership with the member as required by CMS.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS).
Develop appropriate clinical algorithms, pathways and call scripts to support pharmacy staff in delivering MTM services.
Review and update all algorithms and call scripts with updated clinical guidelines.
Develop documentation standards for clinical outreach.
Collaborate with other CEC staff to develop and maintain a high quality and consistent MTM product.
Assist CEC leadership to develop programs to support STAR ratings outreach.
Provide clinical outreach to members, prescribers, and pharmacy providers in order to enhance care coordination.
Develop a full understanding of Navitus' Clients' member experience and how the engagement center contributes to improved health and wellness.
Adhere to compliance and HIPAA regulations.
Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
Other duties as assigned
Qualifications
What our team expects from you?
Education:
In DPH-2 or DPH-3 year. CPhT Preferred.
Experience:
Must be 18 years or older.
Experience working in Microsoft Office suite, particularly Word, Excel, and PowerPoint preferred.
The intern role is considered a learning opportunity and as such, no specific experience is required. Preference may be given to candidates with work experience or education paths determined desirable by the department each intern supports.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program - up to $750!
#LI-Remote
Location : Address Remote Location : Country US
$17.8-20.9 hourly Auto-Apply 20d ago
Quality Assurance Coordinator
Delta Dental Washington Dental Service 4.9
Delta Dental Washington Dental Service job in Spokane, WA
Do you have an eye for detail and a passion for ensuring our customers have the best experience possible? If so...this role is for you! Our Quality Assurance Coordinators develop and maintain a system to assure that all claims, calls, texts and online communication, Group Administration tasks, and Provider Services tasks are handled by Delta Dental of Washington consistently and meet the company's established standards, the customer's specifications, and achieves outstanding quality and reliability levels. This role will work closely with our Operations Managers, Supervisors, and our Training team.
At Delta Dental of Washington our vision is that all people can enjoy good oral and overall health, with no one left behind. We succeed because of a shared commitment to a set of values that guide everything we do - for our customers, for our communities, and for each other. We are Accountable. We lean in with Courage. We stay Curious. We are Inclusive. We act with Integrity.
We offer a highly competitive medical, dental and vision plans as well offering a generous 401k match and all employees start accruing vacation and sick time from their very first day. We empower employee development through our tuition reimbursement plan, professional development plans, and employee-led communities.
The pay range for this position In Western Washington varies between $40,905.00 - $55,298.00, and for Eastern Washington varies between $40,560.00 - $54,416.00. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza intends to offer the selected candidate a base pay within this range, dependent on job-related, non-discriminatory factors such as experience. Base pay will also be adjusted based on the candidate's geographic location.
Essential Responsibilities include the following: The list of responsibilities listed is not intended to be comprehensive. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza reserve the right to change the responsibilities at any time with or without notice.
* Evaluate claim quality for Operations. Maintain audit performance statistics and error trends.
* Review our Service Specialists and Support Team inbound calls to offer feedback based on ability to provide exceptional customer service focused on the customer experience, employee experience, ability to display empathy and build a connection with our customer and provide valuable information while strengthening our brand.
* Review and evaluate online communication via text, chat and/or email to ensure that exceptional written communication is provided to our customers.
* Review and evaluate daily Group Administration transactions for retro adjustments, new groups, data entry transactions, and specific document processes.
* Review and evaluate PSR updates including, address changes, TIN changes, and EFT adjustments associated with TIN adjustments, network adds, credentialing and recredentialing.
* Partner and collaborate monthly with Operations Training Dept. to review performance and potential areas for associate development.
* Maintain current knowledge base of these consistently changing entities: Dental on Demand system enhancements and modifications, procedural documentation, contract terms, federal and state regulations, Delta Dental Plans Association policies and procedures and any other information pertaining to accuracy.
* Maintain open communication between Quality Management and Operations Leadership and staff, building open lines of communication to strengthen the team's relationship with all groups.
The experience, skills, and education needed to succeed in the position are outlined below. These requirements are representative of the knowledge, skills, and abilities required to successfully perform the essential functions of the role.
* One year call center, claims processing, Provider Services and/or Group Administration experience required.
* Effective communication skills (both written and oral)
* Proven skills in working independently and as part of a team, while using discretion in decision making and good judgment in problem solving
* Proficient PC skills, experience with Excel and Access
* A high degree of impartiality and confidentiality when reviewing work to insure objective reporting
* A strong desire to perform well and continue to learn
* High School diploma or equivalent required.
Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
We are committed to the highest standards of information security and HIPAA compliance, ensuring the confidentiality, integrity, and protection of all data. All staff are expected to support this commitment by following relevant policies.
$40.9k-55.3k yearly 13d ago
Operations Systems and Reporting Manager
Delta Dental Washington Dental Service 4.9
Delta Dental Washington Dental Service job in Spokane, WA
Are you a data-driven leader with a passion for driving operational excellence and system enhancements? We are seeking an Operations Systems and Reporting Manager to lead a team focused on enhancing efficiency, ensuring data accuracy, and delivering actionable insights. In this role, you'll oversee daily operations, manage work assignments, and guide a team of analysts and/or specialists through effective coaching, mentorship, and performance management. You'll partner closely with cross-functional departments to analyze operational data, identify process improvement opportunities, and develop reporting solutions that inform strategic decisions. Your ability to translate data into clear insights, streamline workflows, and lead through collaboration will be key to success.
At Delta Dental of Washington our vision is that all people can enjoy good oral and overall health, with no one left behind. We succeed because of a shared commitment to a set of values that guide everything we do - for our customers, for our communities, and for each other. We are Accountable. We lean in with Courage. We stay Curious. We are Inclusive. We act with Integrity.
We offer a highly competitive medical, dental and vision plans as well offering a generous 401k match and all employees start accruing vacation and sick time from their very first day. We empower employee development through our tuition reimbursement plan, professional development plans, and employee-led communities.
The pay range for this position In Western Washington varies between $92,900 - $145,700, and for Eastern Washington varies between $80,800 - $126,900. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza Corp. intends to offer the selected candidate a base pay within this range, dependent on job-related, non-discriminatory factors such as experience. Base pay will also be adjusted based on the candidate's geographic location.
Essential Responsibilities include the following: The list of responsibilities listed is not intended to be comprehensive. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza reserve the right to change the responsibilities at any time with or without notice.
* Serve as the primary operations representative for data and performance reporting initiatives
* Partner with cross-functional teams to identify and execute opportunities for operational improvements
* Monitor key metrics, analyze trends and provide insights to leadership to inform strategic decisions
* Manage, mentor, and develop a team of analysts and/or Operations specialists
* Set clear goals and expectations for team members, provide regular feedback, and support professional growth
* Lead performance reviews, manage staffing needs, and guide career development planning
* Collaborate with business units to ensure data accuracy, consistency, and alignment across systems
* Oversee quality control, data governance, and compliance with company standards
* Develop and maintain Tableau dashboards, and performance reports to visualize key operational trends
* Use SQL to extract, validate, and analyze data from multiple systems to support business needs
* Support Internal and External audits and ensure adherence to regulatory and data governance
The experience, skills, and education needed to succeed in the position are outlined below. These requirements are representative of the knowledge, skills, and abilities required to successfully perform the essential functions of the role.
* Bachelor's degree preferred, with at least 3 years of relevant experience in analytics and 1-2 years in a leadership or supervisory role.
* Strong background in process improvement and workflow optimization
* Proficient in SQL for data extraction, analysis, and reporting
* Skilled in Tableau for building and maintaining dashboards and performance reports
* Excellent problem-solving and critical thinking skills with the ability to make sound, timely decisions
* Proven ability to manage multiple priorities and allocate resources effectively
* Strong Interpersonal and communication skills with the ability to collaborate across departments
* Commitment to continuous learning, adaptability, and fostering a positive team culture
Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
We are committed to the highest standards of information security and HIPAA compliance, ensuring the confidentiality, integrity, and protection of all data. All staff are expected to support this commitment by following relevant policies.
$92.9k-145.7k yearly 13d ago
Documentation and Training Specialist
Delta Dental Washington Dental Service 4.9
Delta Dental Washington Dental Service job in Colville, WA
Are you ready to play a key role in ensuring the accuracy of documentation and enhancing training for our frontline teams? We are looking for a Documentation and Training Specialist to support both documentation and training functions. In this role, you will create and maintain documentation that serves as the foundation for training, process analysis, and system modifications, while also assisting Trainers with expertise in projects, meetings, work groups, and training sessions to ensure clear communication of workflows and policies to support frontline staff.
At Delta Dental of Washington our vision is that all people can enjoy good oral and overall health, with no one left behind. We succeed because of a shared commitment to a set of values that guide everything we do - for our customers, for our communities, and for each other. We are Accountable. We lean in with Courage. We stay Curious. We are Inclusive. We act with Integrity.
We offer highly competitive medical, dental and vision plans as well offering a generous 401k match and all employees start accruing vacation and sick time from their very first day. We empower employee development through our tuition reimbursement plan, professional development plans, and employee-led communities.
The pay range for this position in Eastern Washington varies between $45,083 - $60,946. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza Corp. intends to offer the selected candidate a base pay within this range, dependent on job-related, non-discriminatory factors such as experience. Base pay will also be adjusted based on the candidate's geographic location.
Essential Responsibilities include the following: The responsibilities listed are not intended to be comprehensive. Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza reserve the right to change the responsibilities at any time with or without notice.
* Write, update, and maintain clear and concise documentation and training materials, ensuring alignment with the latest process and system changes.
* Lead and drive process improvements in documentation, ensuring accuracy, consistency, and up-to-date materials.
* Collaborate with department leadership to address documentation and communication needs for projects.
* Develop and maintain procedural documentation for both internal and external use.
* Manage a centralized repository for all training and process documentation, ensuring easy access and version control.
* Create and deliver training programs (in-person and virtual) on new processes and systems.
* Manage the Operations Trainers' inbox, responding to training-related inquiries promptly and efficiently.
* Serve as a subject matter expert (SME) during training sessions and provide support for application enhancements.
* Regularly update training materials to reflect process and system changes.
* Work with Content Managers and other departments to ensure training materials and documentation needs are met.
* Monitor and manage Lighthouse Licenses, ensuring proper access for new employees and timely updates for departing employees.
* Provide support to Operations Trainers as needed, assisting with training preparation, delivery, and follow-up tasks.
Experience, skills, and education you need to have to succeed in the position: The requirements listed below are representative of the knowledge, skill, and/or ability required to successfully perform the essential functions of the position.
* Experience in writing, updating, and maintaining clear and concise documentation and training materials, ensuring alignment with process and system changes.
* Strong communication skills with the ability to present clearly and confidently in both classroom and virtual settings.
* Ability to provide and receive constructive feedback to foster personal and professional growth.
* Proven organizational skills to plan, prepare, and manage training sessions and maintain accurate documentation.
* Adaptability to adjust training methods based on employee progress and feedback, engaging diverse groups at all staff levels.
* Collaborative mindset, with experience working with departments and leadership to implement process improvements and interdepartmental changes.
* High attention to detail in maintaining training plans, documentation, and systems, with a proactive approach to continuous improvement.
* Ability to manage multiple tasks efficiently, including responding to training-related inquiries and documentation maintenance.
* Proficiency in managing centralized repositories for training materials and documentation, ensuring easy access and version control.
* Ability to travel to other site locations in Washington State as needed.
* Two years of Operations or Provider Relations experience, or one year of training experience, or an equivalent combination of education and experience.
Washington Dental Service and its affiliates, including Arcora Foundation, Delta Dental of Washington, and TriForza are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
We are committed to the highest standards of information security and HIPAA compliance, ensuring the confidentiality, integrity, and protection of all data. All staff are expected to support this commitment by following relevant policies.
Zippia gives an in-depth look into the details of Delta Dental Ins, including salaries, political affiliations, employee data, and more, in order to inform job seekers about Delta Dental Ins. The employee data is based on information from people who have self-reported their past or current employments at Delta Dental Ins. The data on this page is also based on data sources collected from public and open data sources on the Internet and other locations, as well as proprietary data we licensed from other companies. Sources of data may include, but are not limited to, the BLS, company filings, estimates based on those filings, H1B filings, and other public and private datasets. While we have made attempts to ensure that the information displayed are correct, Zippia is not responsible for any errors or omissions or for the results obtained from the use of this information. None of the information on this page has been provided or approved by Delta Dental Ins. The data presented on this page does not represent the view of Delta Dental Ins and its employees or that of Zippia.
Delta Dental Ins may also be known as or be related to DELTA DENTAL OF CALIFORNIA, Delta Dental, Delta Dental Ins, Delta Dental Insurance Company and Delta Dental of California.