Support Specialist jobs at Humana

- 33 jobs

Senior Technology Solutions Professional - AI and Automation
Humana 4.8
Support specialist job at Humana
Become a part of our caring community and help us put health first The Senior Technology Solutions Professional devises an effective strategy for executing and delivering on IT business initiatives. The Senior Technology Solutions Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Job Title: Senior Technology Leader - AEP Readiness & Automation Location: Louisville, KY / Remote Department: Technology Solutions Reports To: Director, Technology Solutions Position Overview: Humana is seeking an accomplished Senior Technology Leadership Professional to drive AEP (Annual Enrollment Period) readiness, leveraging automation to optimize and streamline key business processes. This leader will partner with cross-functional teams to ensure all technology platforms, DevOps practices, and automation initiatives are aligned with organizational goals and compliance requirements, fostering continuous improvement and operational excellence. Key Responsibilities: Lead the technology strategy for AEP readiness initiatives, ensuring high availability, scalability, and resilience of critical systems. Collaborate with Product, Operations, and Compliance teams to define requirements and deliver solutions that meet regulatory and business needs. Architect and implement automation frameworks to streamline processes, reduce manual interventions, and accelerate delivery timelines. Mentor and guide technology teams in the adoption of new tools and practices, fostering a culture of innovation and accountability. Ensure comprehensive documentation and reporting of processes, automation strategies, and metrics for executive leadership. Proactively identify risks, bottlenecks, and areas for improvement, driving remediation and optimization efforts. Maintain up-to-date knowledge of emerging technologies, industry trends, and regulatory requirements relevant to healthcare and AEP operations. Use your skills to make an impact Required Qualifications: 7+ years of experience in technology leadership roles, with demonstrated success supporting large-scale, time-sensitive programs (preferably in healthcare or regulated industries). Deep expertise in DevOps, CI/CD, and process automation within complex enterprise environments. Proven experience implementing and optimizing DevOps governance standards, automation pipelines, and compliance controls (e.g., pipeline templates, automated rollbacks, metrics and KPI tracking, and security integration). Strong project management, analytical, and problem-solving skills. Excellent interpersonal and communication skills with the ability to influence stakeholders at all levels. Preferred Qualifications: Bachelor's degree in Computer Science, Information Technology, Engineering, or related field; Master's degree preferred. Experience with AEP or similar annual readiness events in the healthcare insurance industry. Familiarity with Humana's DevOps platforms, governance standards, and automation frameworks. Certifications in DevOps, Cloud Architecture, or Process Automation (e.g., AWS, Azure, Google Cloud, PMP). Why Humana: At Humana, we invest in our people and technology to deliver transformative solutions that improve the lives of our members and communities. Join us to help shape the future of healthcare technology. Additional Information Work-At-Home Requirements WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information #LI-Remote Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $97,900 - $133,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-11-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$97.9k-133.5k yearly Auto-Apply 14d ago
Application Support Specialist - Remote based in the US
Tenet Healthcare Corporation 4.5
Frisco, TX jobs
The Spec, Application Support is tasked with the optimization and management of specified technology. This position will work closely with various vendors, ensuring the most up-to-date information and changes are evaluated for use and effectiveness in the process. Will work with the process team to determine what technology changes and needs are required to drive process improvements. Will own the development and follow through of any service requests or new implementations. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Stays current and has deep, ingrained knowledge of systems, including end user applications, reporting and enhancements. Can demonstrate full understanding of how the technology supports and is used within specific processes and brings technology driven ideas to the process team. * Reviews all ISB's for procedural impact. Edits and works with process leaders and trainers to develop procedural and training documentation. Clarifies system processes and responds to additional requests for information. * Works closely with peers to reduce redundancies and ensure there are no conflicts between multiple technologies within processes. * Ensures that Software Transfer Implementations are completed accurately and develops test plans. Meets user deadlines for system changes and other requested information. * Coordinates with IS to ensure that facility IS departments have the knowledge required to ensure the front-end system is set up appropriately. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. * Understands workflow and technology needs within the business. * Excellent grammar and writing skills * Must have good organizational skills * Able to work independently with little supervision * Able to communicate with all levels of management * Must have general computer skills and be proficient in Word, Excel, and PowerPoint * Excellent working knowledge of Patient Financial Services operations with specific focus on applicable discipline. * Ability to work and coordinate with multiple parties * Ability to manage projects * Knowledge of AR management technology tools being utilized to deliver on key performance * Knowledge of healthcare regulatory rules and how they apply to revenue cycle operations and outsourcing service providers * Excellent verbal and written communication skills EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * 4-year college degree in Healthcare Administration, Business or related area or equivalent experience * 2 - 6 years of experience in Healthcare Administration or Business Office * Lean, Six Sigma or other process improvement certification is a plus PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Must be able to work in a sitting position, use computer and answer telephone WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Office Work Environment As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation * Pay: $21.70 - $34.70 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * Discretionary 401k match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. #LI-NO3 Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********
$21.7-34.7 hourly 40d ago
Application Systems Programming Specialist (Remote)
Community Health Systems 4.5
Remote
Community Health Systems is seeking an Application Systems Programming Specialist to join its Integration Services team. This advanced technical role is responsible for leading the analysis, design, development, and support of complex system interfaces within a healthcare environment. The specialist will demonstrate expertise in industry trends, best practices, and interface programming using tools such as Mirth, Intersystems, and Rhapsody. Key responsibilities include ensuring seamless data integration, maintaining comprehensive documentation, and providing proactive solutions to optimize system performance. This role requires collaboration with internal and external stakeholders to achieve business objectives and the ability to manage complex technical projects in dynamic environments. Essential Functions Mirth Connect (Primary Focus) Develop, maintain, and monitor HL7/FHIR interfaces using Mirth Connect. Manage channels, transformations, filters, and communication protocols (TCP, SFTP, REST, etc.). Handle Mirth upgrades, performance tuning, and participate in Disaster Recovery/High Availability (DR/HA) documentation and validation. Collaborate with platform specialists to ensure high availability and platform integrity. Troubleshoot production issues and lead root cause analysis across a diverse ecosystem of clinical systems and vendors. Coordinate with offshore/onshore teams for 24x7 support coverage. InterSystems HealthShare (Strategic Focus) Participate in the pilot deployment of HealthShare Health Connect. Build and configure message routes, transformations, and business processes using HealthShare components (IRIS, Ensemble). Support platform consolidation planning across fragmented integration engines. Assist in evaluating cloud-hosted options (e.g., Google Cloud Platform) for future-state deployment. Interoperability & Standards Work closely with the Technical Integration Manager and enterprise architecture team. Implement and support workflows involving HL7 v2/v3, FHIR R4, X12, Continuity of Care Document (CCD), and Clinical Document Architecture (CDA). Contribute to roadmap planning for advanced Health Information Exchange (HIE) participation, API adoption, and care coordination use cases. Documentation & Communication Develop and maintain documentation including design specifications, test cases, support runbooks, and DR plans. Communicate effectively with hospital IT teams, vendors (Cerner, Medhost, Athena), and state agencies. Qualifications Bachelor's degree in Computer Science or Information Technology. 8+ years of hands-on integration engine experience in a healthcare integration environment. 5+ years of hands-on Mirth Connect experience in a healthcare integration environment. Strong working knowledge of HL7 v2.x, FHIR, CCD/CDA, and interfacing protocols. At least 2 years of experience with InterSystems HealthShare (Health Connect or Ensemble). Experience supporting production interfaces in mission-critical hospital or HIE environments. Familiarity with EMRs such as Cerner, Athena, Medhost, or Epic. Basic scripting experience (JavaScript, XSLT, or Python preferred). Ability to contribute to a 24x7 on-call rotation. Preferred Qualifications: Experience with cloud-based integration (Google Cloud Platform preferred). Familiarity with Carequality/CommonWell networks, immunization registries, and HIE frameworks. Understanding of HIPAA, HITECH, and healthcare compliance.
$25k-41k yearly est. Auto-Apply 60d+ ago
IT Specialty Support & Process Improvement
Community Health Systems 4.5
Remote
CHSPSC, LLC seeks an IT Specialty Services Support & Process Analyst to assist with leading escalated support activities and provide process improvement initiatives. The department handles services lines such as Surgery, Anesthesia, OB/Perinatal, and others. The role will be involved with the facilitation of application services management processes pertaining to analyzing value, evaluating risk, prioritizing projects and onboarding new technology requests to ensure alignment with organizational strategies for the service lines. Key responsibilities include: Alignment with the service lines to address escalated support issues Review transition materials from the Project Management Office for application product ownership Develop and maintain application support plans Document current state and contribute to the direction of the application lifecycle management (LCM) roadmap to reduce costs, mitigate risks, and drive growth and revenue Participate in related efforts such as Disaster Recovery exercises, Cyber Table Top exercises, etc. Present to executive leadership on support-related issues Understand current processes and propose more efficient methods Strategic analysis of the enterprise application portfolio including lifecycle management, application rationalization, consolidation and standardization to achieve the department objectives of the organization including reducing variation of redundant or unused applications Understand the definition, implementation and support of portfolio management standards, policies and processes Understand the data driven decisions pertaining to IT project investments Participate in the structure, attributes, taxonomies and nomenclature of service line elements and categories within the repository toolset (ServiceNow) to ensure completeness and accuracy of the list of enterprise IT business applications Collaborate with business partners, technology leaders and department directors to identify and promote adoption of enterprise standards and rationalization of application systems to achieve economic and patient experience improvement goals Provide expertise on decisions and priorities regarding the overall enterprise application portfolio Track application and vendor trends and maintain knowledge of new technologies to support the organization's current and future needs Maintain an awareness of industry standard best practices and apply relevant methodologies for process improvement Participate in application rationalization feasibility analysis and proposals for management and business partners which support the organization's clinical and economic objectives Review and support applications' advantages, risks, costs, benefits and impact on the enterprise business process and goals Develop and maintain productive relationships of trust both within and outside CHS and embrace the authoritative role in respect to maintaining enterprise standards and align others to the strategic direction Collaborate with Audit teams to respond to and mitigate audit findings and manage audit controls related to application systems and LCM Educate peers and business partners on department methodologies and drive adoption of standard process Support and evaluate portfolio risks and recommend mitigation plans Support business impact analysis and application criticality assessments Partner with key business and delivery stakeholders to conduct application and service line reviews including scope, metrics, expenses and net promoter scores to determine the disposition of existing and proposed solutions Communicate timely and accurate status to appropriate levels and stakeholders including the development and delivery of status reports and presentations Required: Results oriented mentality to drive accurate deliverables with appropriate time to market while taking responsibility for the outcomes Customer focused to align services with customer needs Creativity in developing and executing innovative strategies to meet unique customer needs Excellent verbal and written communication, presentation and customer service skills Ability to handle pressure to meet business requirement demands and deadlines Expertise in analyzing and presenting large volumes of data to senior leadership Critical thinking in developing proposals with sound analysis and achievable outcomes Ability to prioritize tasks and quickly adjust in a rapidly changing environment Exceptional analytic problem solving skills Ability to work independently and in a team environment Organizational awareness and the ability to understand relationships to get things accomplished more effectively Preferred: Experience with APM, CMDB and CSDM components within the ServiceNow platform Application product ownership experience Strong relationship management experience Project management experience/certification 2 or more years in an application portfolio/services management role Lean / Six Sigma Green Belt ITIL certifications Qualifications and Education Requirements: Bachelor's degree in Clinical Informatics, Health Science, Information Systems, Computer Science or a related discipline, or 2 years of relevant experience
$27k-33k yearly est. Auto-Apply 59d ago
Epic Technical Support Analyst - Remote
Unitedhealth Group 4.6
Walnut Creek, CA jobs
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** **Epic Technical Capability Group** The Epic Technical Capability Group is responsible for ensuring the stability, performance, and reliability of Epic systems across multiple medical organizations. This team supports Epic client software deployments and upgrades, manages server infrastructure, and provides technical assistance to clinical end users. By maintaining seamless integration and functionality, the group plays a critical role in enabling clinicians to deliver efficient, high-quality patient care. **Epic Client System Administrator** Responsible for managing Epic servers, supporting client software, and assisting clinical end users. This role offers hands-on system administration and opportunities to learn and grow with evolving technologies. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. **Primary Responsibilities:** + Install, configure, migrate, and manage Epic Client Infrastructure on a virtualized delivery platform + Administer and maintain Windows Server environments, with emphasis on Windows Server 2019 + Manage Active Directory, Group Policies, and system-level configurations + Monitor and optimize system performance using tools such as WhatsUpGold and SystemPulse + Configure and support Citrix NetScaler VIPs for Epic services including Hyperspace, Interconnect, and Web BLOB + Administer Citrix XenApp environments for Epic application delivery + Collaborate with Epic Technical Services and internal teams to support upgrades, deployments, and issue resolution + Troubleshoot Epic-related issues and manage ticket queues efficiently + Participate in on-call rotations to support critical infrastructure and respond to incidents + Provide exceptional customer service to clinical and technical stakeholders + Ensure compliance with HIPAA, HITRUST, and internal security standards + Develop and maintain PowerShell scripts for automation and reporting + Support virtualization and cloud architecture initiatives as they relate to Epic infrastructure You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Epic ECSA Certification (Client Systems Administrator) + 5+ years of experience in healthcare IT or enterprise systems administration + Demonstrated ability to manage support tickets and monitor ticket queues + Willing or availability to participate in on-call rotations **Preferred Qualifications:** + Bachelor's degree in Computer Science, Information Systems, or a related field + Microsoft or ITIL certifications (e.g., MCSA, MCSE) + Experience with system monitoring tools such as WhatsUpGold and SystemPulse + Experience with VMware, SCCM, and enterprise backup solutions + Experienced in the following Epic functions: + Hyperspace / Hyperdrive + Care Everywhere + Interconnect + EpicCare Link + Hyperspace Web + Epic Print Service (EPS) + BPC Web + BCA PC + Solid understanding of virtualization and cloud architecture + Advanced proficiency in Windows Server systems and Citrix NetScaler configuration + Proficiency in PowerShell scripting and automation + Familiarity with Epic App Orchard and API integrations + Proven excellent communication, documentation, and problem-solving skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$43k-53k yearly est. 6d ago
Epic Technical Support Analyst - Remote
Unitedhealth Group Inc. 4.6
Walnut Creek, CA jobs
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Epic Technical Capability Group The Epic Technical Capability Group is responsible for ensuring the stability, performance, and reliability of Epic systems across multiple medical organizations. This team supports Epic client software deployments and upgrades, manages server infrastructure, and provides technical assistance to clinical end users. By maintaining seamless integration and functionality, the group plays a critical role in enabling clinicians to deliver efficient, high-quality patient care. Epic Client System Administrator Responsible for managing Epic servers, supporting client software, and assisting clinical end users. This role offers hands-on system administration and opportunities to learn and grow with evolving technologies. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: * Install, configure, migrate, and manage Epic Client Infrastructure on a virtualized delivery platform * Administer and maintain Windows Server environments, with emphasis on Windows Server 2019 * Manage Active Directory, Group Policies, and system-level configurations * Monitor and optimize system performance using tools such as WhatsUpGold and SystemPulse * Configure and support Citrix NetScaler VIPs for Epic services including Hyperspace, Interconnect, and Web BLOB * Administer Citrix XenApp environments for Epic application delivery * Collaborate with Epic Technical Services and internal teams to support upgrades, deployments, and issue resolution * Troubleshoot Epic-related issues and manage ticket queues efficiently * Participate in on-call rotations to support critical infrastructure and respond to incidents * Provide exceptional customer service to clinical and technical stakeholders * Ensure compliance with HIPAA, HITRUST, and internal security standards * Develop and maintain PowerShell scripts for automation and reporting * Support virtualization and cloud architecture initiatives as they relate to Epic infrastructure You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Epic ECSA Certification (Client Systems Administrator) * 5+ years of experience in healthcare IT or enterprise systems administration * Demonstrated ability to manage support tickets and monitor ticket queues * Willing or availability to participate in on-call rotations Preferred Qualifications: * Bachelor's degree in Computer Science, Information Systems, or a related field * Microsoft or ITIL certifications (e.g., MCSA, MCSE) * Experience with system monitoring tools such as WhatsUpGold and SystemPulse * Experience with VMware, SCCM, and enterprise backup solutions * Experienced in the following Epic functions: * Hyperspace / Hyperdrive * Care Everywhere * Interconnect * EpicCare Link * Hyperspace Web * Epic Print Service (EPS) * BPC Web * BCA PC * Solid understanding of virtualization and cloud architecture * Advanced proficiency in Windows Server systems and Citrix NetScaler configuration * Proficiency in PowerShell scripting and automation * Familiarity with Epic App Orchard and API integrations * Proven excellent communication, documentation, and problem-solving skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
$43k-53k yearly est. 6d ago
Care Management Support Coordinator II
Centene 4.5
Remote
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Location: Up to 25% travel. Prefer candidate to live in/around San Antonio, Austin, McAllen, Corpus Christi, or Temple, TX. Candidate MUST live in TX. Position Purpose: Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines. Provides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service May apply working knowledge of assigned health plan(s) activities and resources Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health (SDOH) needs Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires a High School diploma or GED Requires 1 - 2 years of related experience Location: Up to 25% travel. Prefer candidate to live in/around San Antonio, Austin, McAllen, Corpus Christi, or Temple, TX. Candidate MUST live in TX. Pay Range: $17.50 - $27.50 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$17.5-27.5 hourly Auto-Apply 21d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Columbus, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.2-38.4 hourly 24d ago
Cardiology Technical Support Analyst - National Remote
Unitedhealth Group 4.6
Minnetonka, MN jobs
**Opportunities at Change Healthcare** , part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: **Caring. Connecting. Growing together. ** You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Answering support calls and working with fellow support team members and internal software development groups to identify and resolve problems + Diagnosing software and hardware malfunctions as well as troubleshooting network problems relating to the system + Providing remote systems administration to customer sites + Providing remote software support and analysis to customers + Performing proactive system maintenance check to ensure proper system functionality + Following up on support issues proactively to provide timely updates and resolutions to customers + Maintaining a highly professional and customer centric focus + Providing ongoing product feedback to engineering and product development teams + Continually seeking opportunities to increase customer satisfaction and deepen customer relationships + Participate in various projects You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + High School Diploma/GED (or higher) + 2+ years of experience in a technical support environment + Intermediate level of proficiency in Windows operating systems + Intermediate level of proficiency in TCP/IP networking and routing + Ability to work 8:30 am - 5:00 pm EST + Ability to do on-call duty, one week in duration and on a rotational basis every 3-5 weeks (compensation will be provided for the additional work) **Preferred Qualifications:** + Bachelor's degree (or higher) of Computer Science, Engineering or Computer Technology background + Background Supporting Hospital Enterprise systems + Knowledge of Dicom and HL7 standards **Soft Skills:** + Proven excellent customer service skills + Proven excellent written and verbal communication skills + Demonstrates highly developed organizational skills and time management ability + Demonstrates thrive in working in a fast-paced environment, multi-task and demonstrate flexibility + Proven self-starter and team player with exceptional commitment to providing superior proactive customer service + Proven ability to learn quickly in a high pace, challenging environment **Working Conditions/Physical Requirements:** + Shift work required. The Support group is open from 7am to 9pm ET. The start times vary on a weekly basis and are rotated within the assigned team + General office demands *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. The salary range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. **_Application Deadline:_** _This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants._ _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._ \#RPO #GREEN
$37k-45k yearly est. 60d+ ago
Cloud Specialist
Community Health Systems 4.5
Remote
Community Health Systems is seeking cloud specialist for The Cloud Center of Excellence (CCoE) which is building a scalable, secure, and cost-efficient multi-cloud foundation across Google Cloud Platform (GCP), Oracle Cloud Infrastructure (OCI), and Microsoft Azure. This role will play an integral part roles enable seamless collaboration across architecture, engineering, data, and security teams-driving modernization, cost optimization, and compliance through CCoE best practices. Key Responsibilities: Work collaboratively with architecture team in design, deployment, and governance of enterprise-scale cloud infrastructure. Implement automation frameworks, landing zones, and security controls. Champion FinOps initiatives to optimize spend and performance. Guide with CI/CD pipelines and infrastructure-as-code templates (Terraform, Ansible). Troubleshoot complex multi-cloud issues and guide operational excellence. Collaborate with architecture, security, and data teams to enforce compliance and resilience. Required Qualifications: Bachelor's or Master's in Computer Science, IT, or related discipline. 7-10 years in cloud engineering, DevOps, or platform architecture roles. Deep experience in GCP and OCI; exposure to Azure preferred. Proficiency in Terraform, Kubernetes, and CI/CD frameworks. Strong documentation, troubleshooting, and mentorship skills. Preferred certifications: Google Professional Cloud Architect OR OCI Architect Professional OR Azure Solutions Architect Expert. Soft Skills: Strong troubleshooting and analytical mindset Clear verbal and written communication Team player with ability to work independently and under pressure Strong documentation and customer-facing collaboration skills Why Join Us? Be part of a mission-driven organization serving over 65 hospitals and clinics Contribute to high-impact interoperability and modernization initiatives Work with next-generation platforms Grow within a high-performing integration and data engineering team
$25k-30k yearly est. Auto-Apply 52d ago
Practice Transformation Specialist
Community Health Systems 4.5
Remote
This position will schedule virtual or (permitting) in-person visits to assigned provider practices. This position serves as a consultant to assist in the transition to value-based care by enhancing provider practice skills in process improvement and quality, sharing identified practice population trends, and analyzing data and performance measurements. The position will be hybrid/remote. Essential Duties and Responsibilities Support operations, promote development, and maintain industry knowledge related to: Accountable Care Organizations (ACOs) Clinically Integrated Networks (CINs) Other value-based care models as applicable Provide data support to providers by exporting data, running reports, and analyzing trends, and demonstrate proficiency in interpreting the key insights and improvement areas to communicate to practices. Provide general support of payer-driven and value-based quality programs. This includes but is not limited to Medicare Traditional and Advantage, Commercial, governmental, ACO, BPCI, CJR, and other quality-related and value-based reimbursement programs. Schedule monthly/quarterly visits to assigned group practices in order to assist the physicians and staff with practice transformation action plans and update on progress toward established goals. Support annual regulatory reporting submission requirements related to Medicare Quality programs (CQM, eCQM, MIPS, etc.) through coordination of data collection and submission. Assist as needed in EMR data extraction, chart reviews, and quality data collection for assigned practices. Develop deep practice understanding by listening to providers and staff to help identify areas for improvement. Understand practice-level challenges and barriers to achieving goals and share solutions for effectively resolving these issues. Partner with assigned practices to train clinicians and office staff on workflows to incorporate into their daily activities that drive toward outcomes in the practice that improve care and reduce costs. Collaborate on the development of training materials, project plans, tool kits, and evaluation materials. Deliver practice-level training and toolkits for improving member care. Review performance reports, quality dashboards and identify and develop suggestions for improvement plans for assigned practices. Willingness to travel in assigned regions as needed. Qualifications Required Education: Bachelor's Degree from accredited school/university. Preferred Education: Masters degree in relevant field preferred, relevant clinical/operational experience can be substituted. Local candidates are preferred but will consider Remote *** Up to 20% travel required*** Required Experience: 3-5 years of experience in practice engagement or operations, nursing, health technology, healthcare coding, population health, office management, or other healthcare related fields. Excellent verbal/written communication, interpersonal, and customer service skills. Moderate analytic knowledge needed to interpret and explain reports. Preferred Experience: Experience with Electronic Health Records (EHR) for clinical/practice management processes. Computer Skills Required: Proficient in Microsoft Office products such as Word, Excel, PowerPoint, email applications and in at least one analytics platform.
$25k-30k yearly est. Auto-Apply 26d ago
Registered Principal Support Specialist
Primerica 4.6
Remote
Join Our Team In 2025, USA Today recognized Primerica as a Top Workplace USA for the fifth year in a row, and Newsweek named Primerica one of America's Greatest Workplaces for Diversity for the second consecutive year. In 2024, the Atlanta Journal-Constitution named Primerica as a Top Workplace for the eleventh consecutive year, and Forbes recognized Primerica as one of America's Best Employers for Women for the fifth year in a row. In addition, for the tenth time Primerica has been voted a Best Employer by Gwinnett Magazine. Primerica is a great place to work! About this PositionThe Golden Circle Telephone Rep monitors and responds to top producers' telephone inquiries. The associate also functions as a sales partner to assigned Securities Rep and works with management to make and implement recommendations concerning department changes, improvements and enhancements.Responsibilities & Qualifications Responsibilities & Qualifications Bachelor's Degree (preferred) or 3 years work experience in the Securities Industry. Series 6 and 26 or 7 and 24 licenses required or may be obtained through a learning agreement. Knowledge of individual securities and market dynamics preferred. Effective writing, presentation, communication and coaching skills. Effective problem solving/analysis skills. Excellent PC computer skills. Excellent interpersonal skills. Ability to manage multiple priorities and quickly and efficiently adapt to changes in procedures or policies. Ability to perform assigned tasks within the specified time frames and meet quality expectations. FLSA status: This position is exempt (not eligible for overtime pay): NoOur Benefits: Day one health, dental, and vision insurance 401(k) Plan with competitive employer match Vacation, sick, holiday and volunteer time off Life and disability insurance Flexible Spending Account & Health Savings Account Professional development Tuition reimbursement Company-sponsored social and philanthropy events It has been and will continue to be the policy of Primerica, Inc., and its subsidiaries to be an Equal Opportunity Employer. We provide equal opportunity to all qualified individuals regardless of race, sex, color, religious creed, religion, national origin, citizenship status, age, disability, pregnancy, ancestry, military service or veteran status, genetic or carrier status, marital status, sexual orientation, or any classification protected by applicable federal, state or local laws. At Primerica, we believe that diversity and inclusion are critical to our future and our mission - creating a foundation for a creative workplace that leads to innovation, growth, and profitability. Through a variety of programs and initiatives, we invest in each employee, seeking to ensure that our people are not only respected as individuals, but also truly valued for their unique perspectives.
$28k-38k yearly est. Auto-Apply 60d+ ago
PDM Specialist
Centene 4.5
Remote
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Indiana Medicaid and Managed Care Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Position Purpose: Maintain accurate databases and reports to monitor network compliance with State requirements Create and maintain multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections Oversee the provider termination process including adding and changing new or existing provider records in the medical information system Schedule monthly provider verifications regarding provider enrollment specifications and demographic changes Update delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance Provide appropriate reports and statistical data to other department designees for review, follow-up and resolution Perform general administrative tasks in support of assigned department Performs other duties as assigned. Complies with all policies and standards. Education/Experience: High school diploma or equivalent. 2+ years of provider data or network administration experience, preferably in a managed care setting. Associate's degree in health care or a related field preferred. Pay Range: $19.04 - $32.35 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$19-32.4 hourly Auto-Apply 28d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Cleveland, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.2-38.4 hourly 24d ago
Specialist, Appeals & Grievances
Molina Healthcare Inc. 4.4
Cleveland, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties * Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. * Meets claims production standards set by the department. * Applies contract language, benefits and review of covered services to claims review process. * Contacts members/providers as needed via written and verbal communications. * Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). * Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. * Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. Required Qualifications * At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. * Customer service experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. * Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.2-38.4 hourly 25d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Akron, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.2-38.4 hourly 24d ago
Appeals & Grievances Specialist (Complaints & Grievances)
Molina Healthcare Inc. 4.4
Dayton, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties * Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. * Meets claims production standards set by the department. * Applies contract language, benefits and review of covered services to claims review process. * Contacts members/providers as needed via written and verbal communications. * Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). * Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. * Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. Required Qualifications * At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. * Customer service experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. * Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.2-38.4 hourly 17d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Dayton, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.2-38.4 hourly 27d ago
Appeals & Grievances Specialist (Complaints & Grievances)
Molina Healthcare Inc. 4.4
Ohio jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties * Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. * Meets claims production standards set by the department. * Applies contract language, benefits and review of covered services to claims review process. * Contacts members/providers as needed via written and verbal communications. * Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). * Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. * Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. Required Qualifications * At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. * Customer service experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. * Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.2-38.4 hourly 17d ago
Appeals & Grievances Specialist (Complaints & Grievances)
Molina Healthcare 4.4
Ohio jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.2-38.4 hourly 16d ago

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Specialist, Appeals & Grievances

Specialist, Appeals & Grievances

Appeals & Grievances Specialist (Complaints & Grievances)

Specialist, Appeals & Grievances

Appeals & Grievances Specialist (Complaints & Grievances)

Appeals & Grievances Specialist (Complaints & Grievances)

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