FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
Join Independent Health and Our Family of Companies!
We're excited to announce an excellent opportunity for full-time Customer Service Representatives starting on February 23rd, 2026.
Training:
Approximately 10 weeks of paid, on-site training
Monday-Friday, 8:00AM - 4:30pm
Location: 250 Essjay Rd., Williamsville, NY
Schedule:
After training, this role transitions to a hybrid work arrangement
You'll be assigned a regular shift between 8:00 AM and 8:00 PM
Shift Preferences will be discussed after training
Occasional Overtime may be required, including holidays and weekends, based on business needs
Pay Rate:
$19 per hour
Overview
The Customer Service Representative (CSR) is responsible for displaying confidence, passion for service, and practicing empathetic listening while connecting to Independent Health members. The CSR actively listens, assesses needs and utilizes system tools and resources to address and resolve inquiries. In addition, the CSR makes appropriate process or regulatory determinations and follows escalation procedures when deemed appropriate. The CSR is called on to research complex issues pertaining to benefits, claims, plans, and eligibility across multiple databases which requires fluency in computer navigation and toggling while confidently and compassionately engaging with the member.
Qualifications
High school diploma or GED required.
Prior experience and success working in a customer service focused environment required.
Previous experience working in a call center preferred.
Knowledge of CPT codes, ICD-9 coding, and medical terminology preferred.
Excellent written and verbal communication skills. Ability to communicate with internal and external customers effectively and efficiently. Must be able to work collaboratively.
Ability to think critically and listen with intent to understand.
Ability to adapt behavior based on constructive feedback to improve job performance.
Proficient in problem solving and ability to prioritize accordingly.
Microsoft Office experience required with the ability to talk and type simultaneously. Must demonstrate proficiency in balancing keyboard accuracy with speed, the ability to correctly transmit data, and the ability to work efficiently while producing excellent customer service experiences.
Strong organizational and time management skills.
Ability to assume responsibility and maintain confidentiality. Strong sense of accountability is required.
Flexibility to work additional hours as required by department. Flexibility in shift assignment required. Must have availability to work a shift between 8:00 a.m. and 8:00 p.m. during normal business hours. Weekend shifts and holidays may occasionally be required.
Ability and willingness to meet with customers face to face at alternate locations when business needs require.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Service Customers
Provide excellent customer service when responding to customers and de-escalate customers as needed.
Relay accurate and up-to-date information on policies and procedures and communicate a successful resolution to inquiries.
Document all calls accurately and timely.
Escalate issues to the appropriate resources as outlined in policy and procedure guides.
Meet or exceed all quality, productivity, accuracy, and call identification goals as stated in the most current departmental policy.
Maintain Core Knowledge
Maintain technical knowledge regarding Independent Health's contracts and benefits and working knowledge of policies, procedures, and updates daily.
Attend required training sessions as needed (including remote and onsite learning).
Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards.
Technology Requirements
Utilize multiple systems and tools to obtain needed information related, but not limited to:
Claims.
Enrollment.
Authorizations.
Finance.
Accounts Receivable.
Reference Screens.
Providers.
Ability to determine claim status and whether claim is adjudicated properly. Must have knowledge and ability to make claim adjustments using established criteria.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $19 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$19 hourly Auto-Apply 14d ago
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Prior Authorization Assistant
Independent Health Association 4.7
Independent Health Association job in Buffalo, NY
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
The Prior Authorization Assistant facilitates the triage, logging in and out of all prior authorization, appeal and grievance requests, and follow-up on said requests, to ensure that all requests are resolved and completed in a timely manner. The Assistant ensures that all steps involved with the process are completed and all regulatory requirements are met or exceeded.
The Assistant may also be assigned to provide high quality, diverse administrative support including but not limited to: faxing prior authorization requests, completing decision letters-faxing and copying, filing, and document scanning preparation. Occasional holidays, weekends and overtime are a requirement of the position.
Qualifications
High School diploma or GED required; Associates degree preferred.
One (1) year of experience in pharmacy and/or health insurance operations required OR total six (6) months non-PBD associate (temporary) experience working within the same positions and/or department required. Pharmacy experience strongly preferred.
General knowledge of drug names, therapeutic categories, dosage forms, manufacturers and packaging preferred.
Familiarity with HMO concept, PC skills and pharmacy on-line system preferred.
Proven written and verbal communication skills.
Excellent organizational and time management skills.
Excellent ability to absorb new concepts and adapt to a changing environment.
Exhibit creativity and self-motivation, with ability to effectively solve problems as they arise.
Demonstration of math aptitude for purposes of calculating simple drug requirements when given doses and prices calculations.
Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.
Essential Accountabilities
Prior Authorization, Appeal & Grievance Request Coordination
Assist Clinical Review Pharmacist in making appropriate decision by verifying member and provider eligibility and filing requests into the correct member folder. (Standard: 2 minutes per request /all requests will be triaged within 2 hours of receipt).
Enter data and ensures complete accuracy on all statistics by logging prior authorization requests into pharmacy systems. (Standard: 3.5 minutes per request / All requests will be logged in by end of business day.
Updating information in required documentation systems. May also include transcribing Medical Director decision into systems. (Standard: 7 minutes per request/all requests will be completed within 24 hours of a pharmacist decision).
Correspondence
Provide Support for all required letters within required timeframes.
Fax prior authorization requests including requests for additional information and completed requests.
Copy and mail completed requests and related documents.
Prepare completed requests for scanning into documentation systems.
Maintain proper storage of all files, in accordance with the corporate retention policy.
Drug Policy Maintenance
Assist the Supervising Pharmacist, Prior Authorization with copying and maintaining drug policies.
Update the drug policy tracker accurately and timely.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $20.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$20 hourly Auto-Apply 5d ago
HR Coordinator
Independent Health 4.7
Independent Health job in Buffalo, NY
FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. The HR Coordinator will be responsible for a variety of administrative functions supporting the HR department. The HR Coordinator will work with the department on carrying out various human resources programs and initiatives including but not limited to talent acquisition, workforce development and associate engagement. The HR Coordinator will assist with high-volume recruitment, maintain relationships with community organizations and represent IH at job fairs and community events. The Coordinator will also assist with the onboarding process including but not limited to administration and tracking of pre-employment screening and the contingent worker process. The Coordinator will respond to and resolve associate inquiries and triage or escalate issues as appropriate within HR. The Coordinator will contribute to the success of human resources practices and objectives that will provide an associate-oriented, high-performance culture reflecting the IH values on a daily basis.
Qualifications
* High school diploma or GED required. Associates degree preferred.
* Three (3) years of office/clerical experience required; one year of which was in an HR role.
* General knowledge/familiarity with HR principles and practices as related to benefits, recruitment, and onboarding required.
* Strong Microsoft Office experience required.
* Strong attention to detail required.
* Excellent verbal and written communication skills, including correct grammar and punctuation, as well as the ability to create correspondence.
* Ability to demonstrate excellent customer service skills, respond to requests in a timely manner, facilitate the appropriate exchange of information and resolve customer issues.
* Effective organizational and time management skills with the ability to handle multiple projects.
* Ability to work effectively with others in a team like setting to achieve common goals.
* Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
* Coordinate new employee onboarding including being a main point of contact to the new hire, confirming drug/background check requirements are completed and system credentials are obtained.
* Assist Talent Acquisition team with various activities as needed including high volume recruitment, community outreach, phone screens, interview events, and job fairs.
* Coordinate all required regulatory compliance for new hires including the I-9 and wage theft processes, enrollments in required training modules and follow up of incomplete trainings.
* Coordinate the hiring of contingent workers (temps, contractors, and interns) and enroll them into appropriate online trainings.
* Maintain accurate HR data in multiple systems for all new hires/job changes and follow up as needed.
* Provide excellent customer service by handling incoming requests and questions from associates and candidates.
* Create and coordinate associate and new hire communications.
* Provide additional department support as needed (purchasing supplies/catering, processing invoices).
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $23.00 - $26.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
$23-26 hourly Auto-Apply 13d ago
Manager-Financial Planning & Analysis
Independent Health 4.7
Independent Health job in Buffalo, NY
FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. The Manager-Financial Planning and Analysis shall assist in the development and management of the budgeting and forecasting processes, the development of accurate financial projections and assisting in the creation of long-term strategic plans to support the company's income and growth objectives. Duties shall include conducting financial analysis, modeling, forecasting, and the preparation of monthly management reporting to ensure efficient financial operations. They will provide financial and strategic decision support to senior management analyzing financial data and operational trends to identify opportunities and risks and make recommendations. Additionally, they will identify areas for further research based on analysis of historical data, market trends, leading indicators, and business statistics.
The Manager-Financial Planning and Analysis will build collaborative working relationships with business leaders and other partners in support of key priorities and objectives to ensure a thorough and well-informed forecast process. They will demonstrate resourceful and collaborative expertise that results in favorable outcomes and helps to differentiate Independent Health as a leader in providing affordable high-quality health benefit solutions.
Qualifications
* Bachelor's degree in finance, accounting or a related field is required. MBA or CPA preferred. An additional four (4) years of experience will be considered in lieu of a degree.
* Five (5) years of experience in financial planning and analysis, process management, and relevant project leadership required.
* Two (2) years of management experience required.
* Comprehensive knowledge of financial statement analysis, forecasting, and KPI reporting.
* Experience in health insurance forecasting and management reporting preferred.
* Knowledge of GAAP accounting.
* Strong analytical and problem-solving skills to prepare and analyze complex financial data.
* Ability to interpret and summarize results of variance analysis in a meaningful way.
* Understanding of utilizing financial models and leveraging data from reporting to drive financial results.
* Proficiency in financial software and systems, including ERP, financial modeling, and reporting tools. Workday Financials/OfficeConnect experience preferred.
* Strong interpersonal and communication skills and the ability to work effectively with a wide range of associates across multiple business areas.
* Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Management/Leadership
* Recruit, develop, and mentor a high-performing FP&A team and foster a culture of collaboration, accountability, and continuous learning.
* Oversee the finance business partner team which will include engaging with internal customers to analyze, design, and implement financial solutions that will give them the information and knowledge required to make timely and sound financial decisions.
* Promote a collaborative working environment, building strong relationships with cross-functional teams and promoting effective communication across the organization.
Strategic Planning and Budgeting
* Support the annual strategic planning and budgeting process, collaborating with product owners and department heads to align financial objectives with overall corporate goals.
* Work closely with executive leadership, to prepare and review all budget information for approval by the Board of Directors.
* Align and prioritize initiatives to the annual operating and strategic plans and perform forecasting to provide visibility into business results to enable business decisions.
* Partner with cross-functional teams to develop and refine strategic initiatives as well as evaluate business opportunities and investments.
Analysis and Reporting
* Develop and maintain robust financial models to support strategic decision-making, including long-range planning, annual budgeting, and quarterly forecasting.
* Analyze financial and operational data to identify and explain variances, trends, opportunities, and risks, providing insights to senior leadership to drive actionable outcomes.
* Lead the preparation of comprehensive monthly management reports and presentations for executive management.
* Prepare ad-hoc executive analysis and reporting as required, summarizing key points of interest in support of the organization's financial objectives.
* Conduct scenario analysis and sensitivity testing to assess the potential impact of various strategic decisions on financial performance.
* Work with business to establish key performance indicators (KPIs) and metrics to monitor business performance, tracking actual results against budget and forecast.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $110,000 - $125,000 annually
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
$110k-125k yearly Auto-Apply 60d+ ago
Actuarial Analyst Senior-PT
Independent Health 4.7
Independent Health job in Buffalo, NY
FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. The Actuarial Analyst-Senior-PT will provide a full scope of actuarial and statistical analyses. Such projects will support both internal and external customers. The position will require strong analytical skills and working collaboration with other team members and business units throughout the organization.
Qualifications
* Bachelor's degree required in Mathematics, Statistics, Actuarial Sciences, or related field. Master's degree preferred.
* Five (5) years of Actuarial or related experience required.
* Completion of at least one Society of Actuaries exam preferred.
* Strong understanding of actuarial concepts, functions, and processes and how they relate to the enterprise, including how they impact operations and financials.
* Expert understanding of health care concepts and products, and detailed understanding of the health care environment including government regulations and competitive landscape.
* Advanced knowledge of Excel, SAS and other analytic or query tools required. Programming and coding experience required.
* Ability to handle data sources, filter and assess data quality, and recognize data patterns required. Strong problem-solving skills are required. Must be able to develop information derived from multiple and varied inputs and communicate and interpret that information.
* Project management skills. Minimal supervision required on projects. Ability to develop and support complex projects.
* Excellent oral and written communication skills. Strong interpersonal skills.
* Self-motivation and initiative, as well as an ability to perform under pressure. Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment.
* Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
* Support the budget development process to include forecasting and actual to budget comparison. Communicate with external departments to support budget preparation. Assess and validate budgetary assumptions.
* Support development and forecasting of accruals for Finance and Accounting for various financial statement items.
* Provide analysis and reporting for financial and regulatory requirements including but not limited to MCR, ROI, product performance, provider and vendor relationships, and audit support.
* Perform actuarial analysis and modeling to include but not limited to reserves, pricing, and forecasting.
* Develop ad hoc reports as a supplement to routine management reports through query building and data extraction.
* Propose and assist in development of process improvements and automation within the department.
* Manage complex projects with complete and thorough understanding of entire process. Responsible for development, support, and improvement of departmental projects with minimal supervision.
* Perform peer review as needed. Provide mentoring and critical analysis to other team members.
* Represent the Actuarial Department to other areas of the company or external constituents. Develop and enact effective communication including senior level management.
* Understand multiple sources of data; able to identify and utilize most relevant source to complete tasks. Ensure overall data integrity. Draw together facts and input from a variety of sources; make recommendations to management.
* Provide support to assist management in meeting corporate goals and strategic decision making.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $45.00 - $56.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
$45-56 hourly Auto-Apply 7d ago
Account Coordinator
Independent Health Association 4.7
Independent Health Association job in Williamsville, NY
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
The Account Coordinator will play a critical role within the Account Management team, serving as a key liaison between internal departments and external clients such as PBMs, health plans, employers, brokers, and other organizations. The Account Coordinator will demonstrate mastery of pharmacy workflow software to facilitate new patient referrals for a successful onboarding process. They will handle client inquiries or issues, support approved processes for new groups and ongoing success for existing groups, and execute account-specific strategies to ensure client satisfaction and retention. This position will work closely with the operations team and help to identify opportunities for process improvement and demonstrate strong understanding of client specific requirements.
Qualifications
High school diploma or GED required.
Three (3) years of experience in pharmacy or account coordination to include customer service and understanding of pharmacy workflow and patient experience required.
Strong organizational, problem-solving, process management, and analytical skills.
Ability to manage multiple priorities including communication flows, managing client portals, processing prescriptions, and facilitation of information to customers.
Strong verbal and written communication skills, with the ability to build effective working relationships across internal teams and external account managers.
Excellent computer skills including Microsoft Office and web-based applications.
Proven examples of displaying the Reliance Rx values: Collaborative, Accessible, Results-Oriented, Empowering, Supportive.
Essential Accountabilities
Support day-to-day prescription workflows to help retain existing business by ensuring timely processing and clear communication with internal teams and external contacts.
Provide dedicated account services in line with contractual obligations and service level agreements.
Coordinate onboarding and ongoing maintenance for new and existing accounts.
Oversee implementation of new or renewing customer accounts.
Tailor service and administrative support to meet individual client needs.
Collaborate with internal teams to meet client expectations and share relevant information.
Accurately intake and enter initial referrals. Log and escalate unresolved customer issues to appropriate team members.
Submit referral bids using appropriate business rates to support growth opportunities.
Identify and report recurring workflow issues to supervisors for process improvement.
Create, coordinate, and track service levels and performance guarantees for assigned clients.
Complete required assessments, including SDOH and payer-defined value cases.
Communicate and ensure compliance with internal policies and procedures and external regulations.
Offer proactive, operations-based solutions to exceed service expectations.
Maintain expertise in technical, strategic, regulatory, and operational areas relevant to the role.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $23.50 - $25.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$23.5-25 hourly Auto-Apply 1d ago
Clinical Account Pharmacist - Northeast Region
Independent Health 4.7
Independent Health job in Buffalo, NY
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
The Clinical Account Pharmacist will be responsible for supporting sales efforts through goals set by Reliance Rx management, supporting non-clinical sales staff, fostering supportive relationships with large practice specialist groups, attending community events, and other duties as needed to promote Reliance Rx's sales efforts from the clinical perspective. The Clinical Account Pharmacist must understand Reliance Rx products, services, distribution channels, the Reliance Rx distribution business, and payer networks. They will build relationships and be comfortable and confident in conducting meetings with physicians, consultants, and pharmaceutical medical affairs personnel. In addition, they will analyze potential client issues and needs and provide a solution to meet or exceed their expectations. The Clinical Account Pharmacist will provide weekly agendas and call/visit logs for regularly scheduled meetings with Reliance Rx leadership. Other responsibilities will also include performance of the duties of an actively licensed staff/specialty pharmacist including dispensing, on-call coverage, vacation coverage, following federal and state regulations, appropriate clinical consultation, and other assigned duties from senior clinical staff and the Supervising Pharmacist.
Qualifications
Bachelor's degree required. Licensed to practice pharmacy in the state of New York required.
Five (5) years of pharmacy experience required. Specialty pharmacy experience preferred.
Clinical knowledge of health or social work needs for the population served.
Ability to interact effectively with physicians and other members of the health care team.
Successful corporate sales/service experience required, preferably in a manufacturer sales or specialty pharmacy industry.
Strong organizational, problem-solving, process management and analytical skills with proven ability to manage multiple priorities and bring projects to completion.
Local and regional (Northeast) travel required. Any Reliance Rx associate who uses a motor vehicle in the course of their duties representing Reliance Rx must be compliant with State Motor Vehicle laws and must follow the Policy that pertains to Driver's License Requirements as a condition of employment.
Strong Microsoft Office skills required; experience with CPR+ preferred.
Excellent verbal, written and interpersonal communication skills.
Proven examples of displaying the Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, Supportive.
Essential Accountabilities
Provide drug information, perform clinical consultation and patient counseling, and communicate with physicians, nurses and patients.
Assist in the development of drug- and disease-specific measurement tools to enhance reporting to all stakeholders.
Contribute to any company RFP responses for product or payor access.
Coordinate generic, biosimilar, and formulary preference strategies to optimize drug utilization, ensure cost-effective prescribing, and support formulary compliance across healthcare systems.
Periodic travel to conferences or industry meetings may be required.
Build a strong professional relationship between Reliance Rx and the regional provider community to facilitate the acquisition of additional prescription volume; seek unique opportunities to further define Reliance Rx's value proposition to its customers.
Meet with external partners periodically to review sales performance, define expectations, and perform gap analysis compared with competition.
Maintain detailed records of all contacts and meetings; create reports and sales analytics when needed; provide backup documentation, call sheets, and other detail on provider engagement as necessary.
Develop and implement strategies to approach potential customers and increase prescription volume.
Collaborate with leadership to define and implement an effective call/office visit plan that meets the company's strategic needs.
Act as liaison between the regional provider community and Reliance Rx operations and clinical staff to resolve issues.
Coordinate and deliver sales presentations.
Ensure accurate Reliance Rx product and company information is communicated through ongoing training and attending meetings with Reliance Rx operations and clinical staff.
Promote and sell the organization's products and services within an assigned geographic area, product range, or list of customer accounts to achieve significant sales targets.
Pursue sales leads; visit existing and new customers who may be of strategic importance to the organization; assess customer needs and suggest solutions; respond to more complex customer inquiries.
Perform staff/specialty pharmacist tasks regularly, including dispensing (checking) prescriptions, counseling patients, reviewing care plans, accepting and making provider calls, and other assigned tasks by senior clinical staff or Supervising Pharmacist.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $120,000 - $135,000 annually
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$120k-135k yearly Auto-Apply 60d+ ago
Community Connections Representative I/II (Buffalo and Rochester)
Excellus Health Plan 4.7
Buffalo, NY job
This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources and assists with navigating resources available and provide assistance with addressing SDoH barriers and care gaps. This position educates and assists with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE): On and Off Marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market - Qualified Health Plan (QHP).
This position requires working occasional evenings and weekends for outreach and community events.
*Must be able to drive independently within the Health Plan regions
Essential Accountabilities:
Level I
• Educates Medicaid, Medicare, and Commercial members on healthcare benefits, and community resources through home visits and outreach.
• Educates and assists members with accessing care, Case Management program and benefits and government cell phone programs.
• Coordinates, plans and attends community events, including school events, health fairs and various community initiatives. Proactively informs and increases awareness of heath care offerings, state regulations and the Excellus/Univera brand/products at said events and within assigned territories.
• Completes scheduled and unscheduled home visits for noncompliance, gaps in care, community resource needs, and other high-risk issues.
• Conducts targeted phone calls for compliance, HEDIS initiatives and health risk assessments.
• Collaborate with Case Management on the status of high-risk member referrals.
• Assists in finding and connecting members to community social services and agencies. Enroll or refer qualified members in a health home.
• Communicates health insurance program options, fundamentals of all the health insurance products, benefits, and associated costs based on analysis of the applicant's situation in Marketplace.
• Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as is required by the Marketplace.
• Interprets a variety of complex instructions from the MFE Training Manual to assist applicants. Provides critical assessment and analysis which effects insurance enrollment for families and children. Presents all aspects of eligibility, enrollment and available products to community audiences.
• Meets with applicants in locations that have additional MFE resource backup.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
Level II (in addition to Level I Essential Accountabilities)
• Manage the incoming Community Connections Referrals.
• Maintain the Community Resource Guide as needed.
• Ensure educational materials and supplies are replenished and available for use.
• Maintain the in-house Food Pantry ensuring all non-perishable items are within use by date.
• Works with management to participate in training process for new hires and team refreshers. Supervise Intern and/or mentor new hires to team; providing first level problem resolution, share Lifetime way cultural expectations, ensure successful on-boarding and engagement in role.
• Works with management on establishing influential relationships in the community within assigned territory.
• Attends community IPA/Navigator Agency as instructed.
• Represents the company in small/large community-based organization meetings as required/complement or collaboration with Community Engagement Program Manager.
• Gain Subject Matter Expertise (SME) level in key focus area; develop training curriculum and facilitate workshop for team in conjunction with management team.
Minimum Qualifications:
NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels
• High school diploma or GED required. Associate degree preferred.
• Minimum of two years of social services, community outreach, or education experience required.
• Marketplace Facilitated Enroller certification preferred.
• Demonstrated problem solving, interpersonal and communication skills.
• Prior experience and working knowledge in Microsoft Suite including Excel and Word.
Level II (in addition to Level I Minimum Qualifications)
• Minimum of two years' experience working in the Community Connections Representative role.
• Marketplace Facilitated Enroller certification required. Maintenance of certification through continuing education/training essential.
• Demonstrated attention to detail.
• Demonstrated leadership skills.
• Demonstrated knowledge and experience of health care industry and Health Plan business.
• Demonstrated ability to organize and represent an organization at community events preferred.
• Highly effective communicator.
Physical Requirements:
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Ability to lift, carry, push, or pull 15 pounds or less.
• Reaching, crouching, stooping, kneeling required.
• Must have a valid Class D license and ability to operate a motor vehicle.
• The ability to hear, understand and speak clearly while using a phone, with or without a headset.
************
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Compensation Range(s):
Level I: Grade N4: Minimum $19.22 - Maximum $30.76
Level II: Grade N5: Minimum $20.02 - Maximum $33.03
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
$37k-45k yearly est. Auto-Apply 60d+ ago
Financial Planning & Analysis Analyst-Senior
Independent Health Association 4.7
Independent Health Association job in Buffalo, NY
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
The Financial Planning and Analysis Analyst-Senior shall assist in the development and management of the budgeting and forecasting processes, the development of accurate financial projections and assisting in the creation of long-term strategic plans to support the company's income and growth objectives. Duties shall include conducting financial analysis, modeling, forecasting, and the preparation of monthly management reporting to ensure efficient financial operations. They will provide financial and strategic decision support to senior management analyzing financial data and operational trends to identify opportunities and risks and make recommendations. Additionally, they will identify areas for further research based on analysis of historical data, market trends, leading indicators, and business statistics.
The Financial Planning and Analysis Analyst-Senior will build collaborative working relationships with business leaders and other partners in support of key priorities and objectives to ensure a thorough and well-informed forecast process. They will demonstrate resourceful and collaborative expertise that will result in favorable outcomes and will help to differentiate Independent Health as a leader in providing affordable high-quality health benefit solutions.
Qualifications
Bachelor's degree in finance, accounting or a related field is required. MBA or CPA preferred. An additional four (4) years of experience will be considered in lieu of a degree.
Four (4) years of experience in financial planning and analysis, process management, and relevant project leadership required.
Comprehensive knowledge of financial statement analysis, forecasting, and KPI reporting.
Experience in health insurance forecasting and management reporting preferred.
Knowledge of GAAP accounting.
Strong analytical and problem-solving skills to prepare and analyze complex financial data.
Ability to interpret and summarize results of variance analysis in a meaningful way.
Understanding of utilizing financial models and leveraging data from reporting to drive financial results.
Proficiency in financial software and systems, including ERP, financial modeling, and reporting tools. Workday Financials/OfficeConnect experience preferred.
Strong interpersonal and communication skills and the ability to work effectively with a wide range of associates across multiple business areas.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Strategic Planning and Budgeting
Support the annual strategic planning and budgeting process, collaborating with product owners and department heads to align financial objectives with overall corporate goals.
Work closely with executive leadership, to prepare and review all budget information for approval by the Board of Directors.
Align and prioritize initiatives to the annual operating and strategic plans and perform forecasting to provide visibility into business results to enable business decisions.
Partner with cross-functional teams to develop and refine strategic initiatives as well as evaluate business opportunities and investments.
Analysis and Reporting
Develop and maintain robust financial models to support strategic decision-making, including long-range planning, annual budgeting, and quarterly forecasting.
Analyze financial and operational data to identify and explain variances, trends, opportunities, and risks, providing insights to senior leadership to drive actionable outcomes.
Lead the preparation of comprehensive monthly management reports and presentations for executive management.
Prepare ad-hoc executive analysis and reporting as required, summarizing key points of interest in support of the organization's financial objectives.
Conduct scenario analysis and sensitivity testing to assess the potential impact of various strategic decisions on financial performance.
Work with business to establish key performance indicators (KPIs) and metrics to monitor business performance, tracking actual results against budget and forecast.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $90,000 - $105,000 annually
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$90k-105k yearly Auto-Apply 60d+ ago
BI Admin I/II/III
Excellus BCBS 4.7
Buffalo, NY job
The BI Administrator is responsible for designing, developing, implementing, securing, and maintaining Business Intelligence (BI) software environments that drive analytical and data driven decision making across the organization. The BI Administrator works closely with project teams, technical teams, data scientists, enterprise data experts, business teams and external vendors to support organizational decision making through systems that turn disparate data into actionable information. This role will engage in one or more of current technologies: Power BI, Power Platform, Databricks, Azure DevOps, Cognos Analytics, SAS, SAS Data Management Studio, R, Python, TIBCO.
Essential Accountabilities:
Level I
• Installs, configures, administers, and troubleshoots BI software environments in order to achieve reliable, highly available, well performing systems.
• Conducts testing, systems troubleshooting, performance optimization and maintenance of BI and analytical platforms.
• Conducts, monitors and maintains system configuration and backups. Monitors system uptime and performance.
• Provides direct technical support to BI user community, triages and engages support of appropriate personnel when needed or BI technical support is not sufficient. Performs and streamlines functions such as managing user and system accounts, network rights and access to BI, analytical and related integrated systems
• Creates and maintains documentation, standards and policies for the form, structure and attributes of the BI applications and systems.
• Research new and upcoming technology.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
Level II (in addition to Level I Accountabilities)
• Serves as a technical expert and mentor to the organization on the administration of BI tools.
• Develops, documents, and enforces policies needed to maintain the integrity of the BI system.
• Interfaces with development teams, software vendors and other parties to ensure BI system best accommodates their needs and makes changes where necessary.
• Proactively plans for growth, system improvements, upgrades and other system activities
• Defines and leads training seminars, users' groups and other educational activities for the organization's BI user community.
• Advises others of technical/business directions, issues and needs. Assists in development of presentations as a technical or subject matter expert.
• Identifies and documents best practices and makes recommendations for standards improvements
• Interacts regularly with business area partners at a high-level presenting recommendations and statuses
• Proactively identifies system risks/issues and provides recommendations
Level III (in addition to Level II Accountabilities)
• Acts as a subject matter expert across a wide range of BI software components, systems, and vendors.
• Responsible for developing, implementing and planning a strategic BI environment crossing multiple lines of business and influencing manager and director levels.
• Identifies and provides long term strategy alignment updates. Considers changes in technology or direction and risks/impacts across organization.
• Mentors and trains other team members.
• Offers the highest level of technical expertise within the team and works as a consultant on the most complex technical BI issues across the organization.
• Continuously optimizes the enterprises analytics assets, including driving change on BI development/administration teams, IT platform teams and business partners.
• Provides leadership with recommendations and status updates through presentations and meetings.
Minimum Qualifications:
NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels
• Bachelor's degree in Computer Science, Information Technology or related field. In lieu of a degree six (6) cumulative years of experience required.
• Prior professional, internship, or co-op experience in reporting or analytical platforms preferred.
• Experience with Business Intelligence, visualization and data science technologies such as, but not limited to, Cognos, Power BI, SAS, Databricks, SQL, R, python.
• Understanding of data warehousing and database design using, but not limited to, Oracle, Azure SQL, AWS Redshift or other database management system.
• Demonstrated skills in quality principles especially root cause analysis and technical problem-solving
• Flexibility to learn and work with a variety of technologies.
• Understanding of application delivery, management structures and reporting procedures.
• Effective communication skills both written and verbal, and across multiple channels of communication.
Level II (in addition to Level I Qualifications)
• Intermediate experience in BI and data science technologies, data warehousing, database design involving, but not limited to, Cognos, Power BI, SAS, Databricks, SQL, R, python, Oracle, Azure SQL
• Intermediate experience in operating systems (windows, Linux) and cloud platforms (Azure, Amazon Web Services (AWS), Google Cloud Platform (GCP), Databricks).
• Intermediate experience in SQL, SAS, python, power shell or other related programming languages.
• Intermediate experience in securing data and analytical platforms using Active Directory or application-based security roles, including Role-Based security practices.
• Intermediate experience in SDLC and DevOps practices.
• Experience in developing training, process documentation and facilitating presentations.
• Master's degree preferred.
Level III (in addition to Level II Qualifications)
• Extensive, advanced experience in BI and data science technologies, data warehousing, database design involving, but not limited to, Cognos, Power BI, SAS, Databricks, SQL, R, python, Oracle, Azure SQL
• Extensive experience in operating systems (windows, Linux) and cloud platforms (Azure, Amazon Web Services (AWS), Google Cloud Platform (GCP), Databricks).
• Advanced experience in SQL, SAS, python, power shell or other related programming languages.
• Extensive experience in securing data and analytical platforms in Azure, AWS or application-based security roles, including Role-Based security practices.
• Extensive experience in SDLC and DevOps practices.
• Extensive experience in presenting technical information to key stakeholders across all levels of the organization.
Physical Requirements:
• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Ability to work in a home office for continuous periods of time for business continuity.
************
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Compensation Range(s):
Level I - Min 60,410 Mid 76,300 Max 96,081
Level II - Min 71,880 Mid 100,632 Max 129,384
Level III - Min 87,766 Mid 122,872 Max 157,978
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
$95k-125k yearly est. Auto-Apply 13d ago
Product Manager-Medicare
Independent Health Association 4.7
Independent Health Association job in Buffalo, NY
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
The Product Manager-Medicare will be responsible for development and/or maintenance for the life cycle of Medicare products. They will continuously assess market needs, consider future technology, competitor products/services and the regulatory environment. The Product Manager will synthesize data from a variety of sources, including profitability, sales projections, client satisfaction levels and operational efficiency, to monitor product performance. They will proactively provide product updates and ensure informed decisions. In addition, they will be a product expert and serve as a liaison among functional areas within the organization and externally for all product-related issues.
Qualifications
Bachelor's degree required. An additional four (4) years of experience will be considered lieu of degree.
Four (4) years of operational healthcare experience with a focus on Medicare programs to include working with government or regulatory agencies such as Centers for Medicare and Medicaid Services (CMS), Department of Health (DOH), Office of Mental Health (OMH), Office of Health Insurance Programs (OHIP), or Office of Medicaid Inspector General (OMIG) required.
Strong understanding of Medicare guidelines, benefit design, and regulatory filing processes.
The ability to synthesize data into useful information and provide recommendations for action. Strong analytical skills, attention to detail and organizational skills.
Successful project management experience with the ability to develop and execute project plans, manage time effectively and stay organized.
Excellent written and public speaking/group presentation skills for all levels. Able to present persuasive arguments related to product recommendations both verbally and in writing.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Lead and/or participate in development and documentation of repeatable product development processes, including active participation from Health Care Services, Pharmacy/PBD, Network Contract Management, Actuarial Services/Finance, Market Research, Marketing, Sales, and Product Operations, among others. Evaluate current products, pricing, membership, financial performance, competitor information, and game theory in the development of an individual, small group, and large group product strategy that aligns with corporate strategy.
Identify risks and opportunities in a timely manner, take initiative and respond quickly to take corrective action and/or maximize opportunities.
Share recommendations, proposals, and status updates with senior leadership for approval. Work with communications to develop collateral to promote products to targeted customers. Provide training to internal departments on products and the product portfolio, as well as any changes within these.
Work collaboratively with sales, marketing, operations, and servicing to understand what customers are buying and why. Understand industry trends and product innovation opportunities to develop new products and features designed to retain, grow, and further engage targeted membership.
Ensure robust QA process is implemented and performed using available resources for regulatory filings, including PBP forms for CMS bid submission, and other required applications and documents
Ensure operational efficiency through utilization of available systems and software to ensure accurate data management and oversight to downstream processes such as collateral development for summary of benefits, annual notice of change, and evidence of coverage. Provide support and leadership to ensure smooth downstream processes.
Function as subject matter expert in the review of proposed laws/regulations, providing interpretation and understanding of implications for the industry and Independent Health, including recommendations for how best to proceed to ensure compliance and alignment with organizational strategic objectives. Manage development and maintenance efforts for Medicare policies and procedures to ensure compliance with requirements.
Work with outside vendors, regulatory entities such as CMS, and industry trade associations as needed to support the Medicare product portfolio.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $72,500 - $85,000 annually
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$72.5k-85k yearly Auto-Apply 22d ago
Care Coordination Assistant
Independent Health Association 4.7
Independent Health Association job in Buffalo, NY
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
The Care Coordination Assistant (CCA) provides administrative support to the Case Management department. The CCA is responsible for assisting the Case Management department in the implementation of case and disease management programs designed to improve the health status of Independent Health members. This includes, but is not limited to, operational aspects including outreach phone calls to members and administrative support as requested.
Qualifications
High School diploma or GED required; Associates degree preferred.
Two (2) years medical office experience required. Case Management and/or care coordination experience preferred.
Working knowledge of medical terminology required.
Solid verbal, written and interpersonal communication skills required. Demonstrated customer service skills required.
Demonstrated proficiency in data entry. Strong MS Office skills required (Word, Excel).
Excellent organization skills, with attention to detail and follow through.
Ability to meet and/or exceed all established performance standards on a consistent basis (i.e., regulatory timeframes, accuracy, and quality).
Demonstrated proficiency with PC navigational skills; MEDecision, Power MHS and Siebel experience preferred.
Knowledge of medical billing procedures, CPT and ICD-9 coding preferred.
Ability to work flexible hours and/or overtime as needed.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Collaborative, Trustworthy and Accountable.
Essential Accountabilities
Ensure data accuracy in the generation of member case/disease management clinical files within the clinical system (MEDecision); appropriately links all scanned/imaging support files; and routes cases to the appropriate clinician queue in accordance with department policies/procedures.
Ensure data accuracy and the timely recording of encounter data into program databases such as MEDecision form tools/Excel files.
Monitor, retrieve, update and route member data in the core administrative systems (Macess, Health Rules, Siebel, Advantmed); facilitates inter-departmental communications with timely and accurate information.
Complete first-tier member outreach activities under the direction of the clinical manager/clinician team; complete health-risk screening, accurately follow scripts/protocols and appropriately identify members requiring higher-level interventions in accordance with department guidelines/policies.
Coordinate services in accordance with department procedures and/or the clinician's care plan. Provides timely updates.
Ensure compliance with all regulatory and departmental requirements. Accountability for attainment of productivity and quality metrics.
Administrative support as needed (i.e. correspondence, filing, data entry, etc.).
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $20.00 - $21.50 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$20-21.5 hourly Auto-Apply 49d ago
Provider Relations Representative
Independent Health 4.7
Independent Health job in Buffalo, NY
FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. This is a great opportunity to join Independent Health and our family of companies!
We are hiring full-time provider relations representatives to start on March 23, 2026.
Training: Approximately 12 weeks of on-site paid training
Monday-Friday, 8am - 4:30pm (511 Farber Lakes Dr, Williamsville, NY)
Schedule: Associates will be assigned a regular shift of 8:00-4:30pm or 8:30-5:00pm.
Pay rate: $20/hr.
Overview
The Provider Relations Representative will be responsible for assisting our provider constituents and providing exceptional customer service. The Provider Relations Representative will answer incoming calls from health care providers including physician offices, ancillary provider offices and facilities and aid with benefit and eligibility questions, billing and payment questions, and EOB explanations. The Provider Relations Representative will focus on first call resolution and navigate various systems and programs efficiently to provide the caller with the appropriate information to resolve their issues. The Provider Relations Representative will develop a relationship with the office staff by providing confident and accurate responses to customer inquiries in a collaborative and professional manner. They will be accountable to meet all performance measures established in the call center to include efficiency and quality metrics as well as first call resolution and attendance.
Qualifications
* High school diploma or GED required.
* Prior experience in customer service required, preferably in a healthcare setting. Experience working with provider offices is strongly preferred. Proven history in a high-volume work environment where organizational and multi-tasking skills are essential.
* Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding preferred.
* Experience in compliance regulations, appeals and grievance knowledge preferred.
* Ability to effectively communicate with internal and external customers.
* Excellent written/verbal communication skills and excellent customer service skills required.
* Ability to resolve conflicts effectively and customer complaints in writing.
* Strong problem-solving skills with ability to prioritize tasks effectively.
* Strong organizational and time management skills.
* Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
* Research and respond to escalated and complex provider and member inquiries, including claim and billing research requests.
* Provide written and verbal response to customer inquiries.
* Identify and analyze educational opportunities internally or externally.
* Identify potential system configuration or billing issues and provide education to the provider to correct errors.
* Act as a customer advocate by providing excellent, accurate customer service when responding to customer requests.
* Utilize up-to-date knowledge of managed care criteria to meet department of health standards.
* Escalate issues as needed to supervisor.
* Log all contacts into appropriate systems and maintain accurate documentation to meet external audit guidelines.
* Meet or exceed all department standards in quality, productivity, and accuracy.
* Maintain technical knowledge regarding Independent Health's contracts and benefits and working knowledge of policies and procedures and updates daily. Attend required training sessions as needed.
* Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards (NCQA, State, CMS etc.), addressing first level complaints and assisting appeals as needed; effectively resolve written inquiries from customers regarding claims, benefits, eligibility, reimbursement and participating providers.
* Knowledge of all systems as needed and the ability to coordinate the use of these tools at the same time.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $20 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
$20 hourly Auto-Apply 13d ago
Manager-Financial Planning & Analysis
Independent Health Association 4.7
Independent Health Association job in Buffalo, NY
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
The Manager-Financial Planning and Analysis shall assist in the development and management of the budgeting and forecasting processes, the development of accurate financial projections and assisting in the creation of long-term strategic plans to support the company's income and growth objectives. Duties shall include conducting financial analysis, modeling, forecasting, and the preparation of monthly management reporting to ensure efficient financial operations. They will provide financial and strategic decision support to senior management analyzing financial data and operational trends to identify opportunities and risks and make recommendations. Additionally, they will identify areas for further research based on analysis of historical data, market trends, leading indicators, and business statistics.
The Manager-Financial Planning and Analysis will build collaborative working relationships with business leaders and other partners in support of key priorities and objectives to ensure a thorough and well-informed forecast process. They will demonstrate resourceful and collaborative expertise that results in favorable outcomes and helps to differentiate Independent Health as a leader in providing affordable high-quality health benefit solutions.
Qualifications
Bachelor's degree in finance, accounting or a related field is required. MBA or CPA preferred. An additional four (4) years of experience will be considered in lieu of a degree.
Five (5) years of experience in financial planning and analysis, process management, and relevant project leadership required.
Two (2) years of management experience required.
Comprehensive knowledge of financial statement analysis, forecasting, and KPI reporting.
Experience in health insurance forecasting and management reporting preferred.
Knowledge of GAAP accounting.
Strong analytical and problem-solving skills to prepare and analyze complex financial data.
Ability to interpret and summarize results of variance analysis in a meaningful way.
Understanding of utilizing financial models and leveraging data from reporting to drive financial results.
Proficiency in financial software and systems, including ERP, financial modeling, and reporting tools. Workday Financials/OfficeConnect experience preferred.
Strong interpersonal and communication skills and the ability to work effectively with a wide range of associates across multiple business areas.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Management/Leadership
Recruit, develop, and mentor a high-performing FP&A team and foster a culture of collaboration, accountability, and continuous learning.
Oversee the finance business partner team which will include engaging with internal customers to analyze, design, and implement financial solutions that will give them the information and knowledge required to make timely and sound financial decisions.
Promote a collaborative working environment, building strong relationships with cross-functional teams and promoting effective communication across the organization.
Strategic Planning and Budgeting
Support the annual strategic planning and budgeting process, collaborating with product owners and department heads to align financial objectives with overall corporate goals.
Work closely with executive leadership, to prepare and review all budget information for approval by the Board of Directors.
Align and prioritize initiatives to the annual operating and strategic plans and perform forecasting to provide visibility into business results to enable business decisions.
Partner with cross-functional teams to develop and refine strategic initiatives as well as evaluate business opportunities and investments.
Analysis and Reporting
Develop and maintain robust financial models to support strategic decision-making, including long-range planning, annual budgeting, and quarterly forecasting.
Analyze financial and operational data to identify and explain variances, trends, opportunities, and risks, providing insights to senior leadership to drive actionable outcomes.
Lead the preparation of comprehensive monthly management reports and presentations for executive management.
Prepare ad-hoc executive analysis and reporting as required, summarizing key points of interest in support of the organization's financial objectives.
Conduct scenario analysis and sensitivity testing to assess the potential impact of various strategic decisions on financial performance.
Work with business to establish key performance indicators (KPIs) and metrics to monitor business performance, tracking actual results against budget and forecast.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $110,000 - $125,000 annually
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$110k-125k yearly Auto-Apply 60d+ ago
Actuarial Analyst Senior-PT
Independent Health Association 4.7
Independent Health Association job in Buffalo, NY
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
The Actuarial Analyst-Senior-PT will provide a full scope of actuarial and statistical analyses. Such projects will support both internal and external customers. The position will require strong analytical skills and working collaboration with other team members and business units throughout the organization.
Qualifications
Bachelor's degree required in Mathematics, Statistics, Actuarial Sciences, or related field. Master's degree preferred.
Five (5) years of Actuarial or related experience required.
Completion of at least one Society of Actuaries exam preferred.
Strong understanding of actuarial concepts, functions, and processes and how they relate to the enterprise, including how they impact operations and financials.
Expert understanding of health care concepts and products, and detailed understanding of the health care environment including government regulations and competitive landscape.
Advanced knowledge of Excel, SAS and other analytic or query tools required. Programming and coding experience required.
Ability to handle data sources, filter and assess data quality, and recognize data patterns required. Strong problem-solving skills are required. Must be able to develop information derived from multiple and varied inputs and communicate and interpret that information.
Project management skills. Minimal supervision required on projects. Ability to develop and support complex projects.
Excellent oral and written communication skills. Strong interpersonal skills.
Self-motivation and initiative, as well as an ability to perform under pressure. Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Support the budget development process to include forecasting and actual to budget comparison. Communicate with external departments to support budget preparation. Assess and validate budgetary assumptions.
Support development and forecasting of accruals for Finance and Accounting for various financial statement items.
Provide analysis and reporting for financial and regulatory requirements including but not limited to MCR, ROI, product performance, provider and vendor relationships, and audit support.
Perform actuarial analysis and modeling to include but not limited to reserves, pricing, and forecasting.
Develop ad hoc reports as a supplement to routine management reports through query building and data extraction.
Propose and assist in development of process improvements and automation within the department.
Manage complex projects with complete and thorough understanding of entire process. Responsible for development, support, and improvement of departmental projects with minimal supervision.
Perform peer review as needed. Provide mentoring and critical analysis to other team members.
Represent the Actuarial Department to other areas of the company or external constituents. Develop and enact effective communication including senior level management.
Understand multiple sources of data; able to identify and utilize most relevant source to complete tasks. Ensure overall data integrity. Draw together facts and input from a variety of sources; make recommendations to management.
Provide support to assist management in meeting corporate goals and strategic decision making.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $45.00 - $56.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$45-56 hourly Auto-Apply 6d ago
Product Manager-Medicare
Independent Health 4.7
Independent Health job in Buffalo, NY
FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. The Product Manager-Medicare will be responsible for development and/or maintenance for the life cycle of Medicare products. They will continuously assess market needs, consider future technology, competitor products/services and the regulatory environment. The Product Manager will synthesize data from a variety of sources, including profitability, sales projections, client satisfaction levels and operational efficiency, to monitor product performance. They will proactively provide product updates and ensure informed decisions. In addition, they will be a product expert and serve as a liaison among functional areas within the organization and externally for all product-related issues.
Qualifications
* Bachelor's degree required. An additional four (4) years of experience will be considered lieu of degree.
* Four (4) years of operational healthcare experience with a focus on Medicare programs to include working with government or regulatory agencies such as Centers for Medicare and Medicaid Services (CMS), Department of Health (DOH), Office of Mental Health (OMH), Office of Health Insurance Programs (OHIP), or Office of Medicaid Inspector General (OMIG) required.
* Strong understanding of Medicare guidelines, benefit design, and regulatory filing processes.
* The ability to synthesize data into useful information and provide recommendations for action. Strong analytical skills, attention to detail and organizational skills.
* Successful project management experience with the ability to develop and execute project plans, manage time effectively and stay organized.
* Excellent written and public speaking/group presentation skills for all levels. Able to present persuasive arguments related to product recommendations both verbally and in writing.
* Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
* Lead and/or participate in development and documentation of repeatable product development processes, including active participation from Health Care Services, Pharmacy/PBD, Network Contract Management, Actuarial Services/Finance, Market Research, Marketing, Sales, and Product Operations, among others. Evaluate current products, pricing, membership, financial performance, competitor information, and game theory in the development of an individual, small group, and large group product strategy that aligns with corporate strategy.
* Identify risks and opportunities in a timely manner, take initiative and respond quickly to take corrective action and/or maximize opportunities.
* Share recommendations, proposals, and status updates with senior leadership for approval. Work with communications to develop collateral to promote products to targeted customers. Provide training to internal departments on products and the product portfolio, as well as any changes within these.
* Work collaboratively with sales, marketing, operations, and servicing to understand what customers are buying and why. Understand industry trends and product innovation opportunities to develop new products and features designed to retain, grow, and further engage targeted membership.
* Ensure robust QA process is implemented and performed using available resources for regulatory filings, including PBP forms for CMS bid submission, and other required applications and documents
* Ensure operational efficiency through utilization of available systems and software to ensure accurate data management and oversight to downstream processes such as collateral development for summary of benefits, annual notice of change, and evidence of coverage. Provide support and leadership to ensure smooth downstream processes.
* Function as subject matter expert in the review of proposed laws/regulations, providing interpretation and understanding of implications for the industry and Independent Health, including recommendations for how best to proceed to ensure compliance and alignment with organizational strategic objectives. Manage development and maintenance efforts for Medicare policies and procedures to ensure compliance with requirements.
* Work with outside vendors, regulatory entities such as CMS, and industry trade associations as needed to support the Medicare product portfolio.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $72,500 - $85,000 annually
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
$72.5k-85k yearly Auto-Apply 23d ago
Prior Authorization Assistant
Independent Health 4.7
Independent Health job in Buffalo, NY
FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. The Prior Authorization Assistant facilitates the triage, logging in and out of all prior authorization, appeal and grievance requests, and follow-up on said requests, to ensure that all requests are resolved and completed in a timely manner. The Assistant ensures that all steps involved with the process are completed and all regulatory requirements are met or exceeded.
The Assistant may also be assigned to provide high quality, diverse administrative support including but not limited to: faxing prior authorization requests, completing decision letters-faxing and copying, filing, and document scanning preparation. Occasional holidays, weekends and overtime are a requirement of the position.
Qualifications
* High School diploma or GED required; Associates degree preferred.
* One (1) year of experience in pharmacy and/or health insurance operations required OR total six (6) months non-PBD associate (temporary) experience working within the same positions and/or department required. Pharmacy experience strongly preferred.
* General knowledge of drug names, therapeutic categories, dosage forms, manufacturers and packaging preferred.
* Familiarity with HMO concept, PC skills and pharmacy on-line system preferred.
* Proven written and verbal communication skills.
* Excellent organizational and time management skills.
* Excellent ability to absorb new concepts and adapt to a changing environment.
* Exhibit creativity and self-motivation, with ability to effectively solve problems as they arise.
* Demonstration of math aptitude for purposes of calculating simple drug requirements when given doses and prices calculations.
* Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.
Essential Accountabilities
* Prior Authorization, Appeal & Grievance Request Coordination
* Assist Clinical Review Pharmacist in making appropriate decision by verifying member and provider eligibility and filing requests into the correct member folder. (Standard: 2 minutes per request /all requests will be triaged within 2 hours of receipt).
* Enter data and ensures complete accuracy on all statistics by logging prior authorization requests into pharmacy systems. (Standard: 3.5 minutes per request / All requests will be logged in by end of business day.
* Updating information in required documentation systems. May also include transcribing Medical Director decision into systems. (Standard: 7 minutes per request/all requests will be completed within 24 hours of a pharmacist decision).
* Correspondence
* Provide Support for all required letters within required timeframes.
* Fax prior authorization requests including requests for additional information and completed requests.
* Copy and mail completed requests and related documents.
* Prepare completed requests for scanning into documentation systems.
* Maintain proper storage of all files, in accordance with the corporate retention policy.
* Drug Policy Maintenance
* Assist the Supervising Pharmacist, Prior Authorization with copying and maintaining drug policies.
* Update the drug policy tracker accurately and timely.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $20.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
$20 hourly Auto-Apply 5d ago
Provider Relations Representative
Independent Health Association 4.7
Independent Health Association job in Buffalo, NY
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
This is a great opportunity to join Independent Health and our family of companies!
We are hiring full-time provider relations representatives to start on March 23, 2026.
Training: Approximately 12 weeks of on-site paid training
Monday-Friday, 8am - 4:30pm (511 Farber Lakes Dr, Williamsville, NY)
Schedule: Associates will be assigned a regular shift of 8:00-4:30pm or 8:30-5:00pm.
Pay rate: $20/hr.
Overview
The Provider Relations Representative will be responsible for assisting our provider constituents and providing exceptional customer service. The Provider Relations Representative will answer incoming calls from health care providers including physician offices, ancillary provider offices and facilities and aid with benefit and eligibility questions, billing and payment questions, and EOB explanations. The Provider Relations Representative will focus on first call resolution and navigate various systems and programs efficiently to provide the caller with the appropriate information to resolve their issues. The Provider Relations Representative will develop a relationship with the office staff by providing confident and accurate responses to customer inquiries in a collaborative and professional manner. They will be accountable to meet all performance measures established in the call center to include efficiency and quality metrics as well as first call resolution and attendance.
Qualifications
High school diploma or GED required.
Prior experience in customer service required, preferably in a healthcare setting. Experience working with provider offices is strongly preferred. Proven history in a high-volume work environment where organizational and multi-tasking skills are essential.
Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding preferred.
Experience in compliance regulations, appeals and grievance knowledge preferred.
Ability to effectively communicate with internal and external customers.
Excellent written/verbal communication skills and excellent customer service skills required.
Ability to resolve conflicts effectively and customer complaints in writing.
Strong problem-solving skills with ability to prioritize tasks effectively.
Strong organizational and time management skills.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Research and respond to escalated and complex provider and member inquiries, including claim and billing research requests.
Provide written and verbal response to customer inquiries.
Identify and analyze educational opportunities internally or externally.
Identify potential system configuration or billing issues and provide education to the provider to correct errors.
Act as a customer advocate by providing excellent, accurate customer service when responding to customer requests.
Utilize up-to-date knowledge of managed care criteria to meet department of health standards.
Escalate issues as needed to supervisor.
Log all contacts into appropriate systems and maintain accurate documentation to meet external audit guidelines.
Meet or exceed all department standards in quality, productivity, and accuracy.
Maintain technical knowledge regarding Independent Health's contracts and benefits and working knowledge of policies and procedures and updates daily. Attend required training sessions as needed.
Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards (NCQA, State, CMS etc.), addressing first level complaints and assisting appeals as needed; effectively resolve written inquiries from customers regarding claims, benefits, eligibility, reimbursement and participating providers.
Knowledge of all systems as needed and the ability to coordinate the use of these tools at the same time.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $20 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here
for additional EEO/AAP
or Reasonable Accommodation
information.
Current Associates must apply internally via the Job Hub app.
$20 hourly Auto-Apply 12d ago
Care Coordination Assistant
Independent Health 4.7
Independent Health job in Buffalo, NY
FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. The Care Coordination Assistant (CCA) provides administrative support to the Case Management department. The CCA is responsible for assisting the Case Management department in the implementation of case and disease management programs designed to improve the health status of Independent Health members. This includes, but is not limited to, operational aspects including outreach phone calls to members and administrative support as requested.
Qualifications
* High School diploma or GED required; Associates degree preferred.
* Two (2) years medical office experience required. Case Management and/or care coordination experience preferred.
* Working knowledge of medical terminology required.
* Solid verbal, written and interpersonal communication skills required. Demonstrated customer service skills required.
* Demonstrated proficiency in data entry. Strong MS Office skills required (Word, Excel).
* Excellent organization skills, with attention to detail and follow through.
* Ability to meet and/or exceed all established performance standards on a consistent basis (i.e., regulatory timeframes, accuracy, and quality).
* Demonstrated proficiency with PC navigational skills; MEDecision, Power MHS and Siebel experience preferred.
* Knowledge of medical billing procedures, CPT and ICD-9 coding preferred.
* Ability to work flexible hours and/or overtime as needed.
* Proven examples of displaying the IH values: Passionate, Caring, Respectful, Collaborative, Trustworthy and Accountable.
Essential Accountabilities
* Ensure data accuracy in the generation of member case/disease management clinical files within the clinical system (MEDecision); appropriately links all scanned/imaging support files; and routes cases to the appropriate clinician queue in accordance with department policies/procedures.
* Ensure data accuracy and the timely recording of encounter data into program databases such as MEDecision form tools/Excel files.
* Monitor, retrieve, update and route member data in the core administrative systems (Macess, Health Rules, Siebel, Advantmed); facilitates inter-departmental communications with timely and accurate information.
* Complete first-tier member outreach activities under the direction of the clinical manager/clinician team; complete health-risk screening, accurately follow scripts/protocols and appropriately identify members requiring higher-level interventions in accordance with department guidelines/policies.
* Coordinate services in accordance with department procedures and/or the clinician's care plan. Provides timely updates.
* Ensure compliance with all regulatory and departmental requirements. Accountability for attainment of productivity and quality metrics.
* Administrative support as needed (i.e. correspondence, filing, data entry, etc.).
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $20.00 - $21.50 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
$20-21.5 hourly Auto-Apply 50d ago
Actuarial Analyst-Associate
Independent Health 4.7
Independent Health job in Buffalo, NY
FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. Under the supervision of the Manager-Actuarial Services, the candidate will provide a full scope of actuarial and statistical analyses. Such projects will support both internal and external customers. The position requires working collaboration with other team members and business units throughout the organization. This role requires strong analytical skills.
Qualifications
* Bachelor's degree required in Mathematics, Statistics, Actuarial Sciences, or related field. Master's degree preferred.
* One (1) year of Actuarial or related experience preferred. (ex. internship)
* Completion of at least one Society of Actuaries exam preferred.
* General understanding of Actuarial concepts, functions, and processes.
* Understanding of basic health care concepts and products, and general understanding of the health care environment.
* Proficient PC skills in a Windows environment. Advanced knowledge of Excel, SAS, and other analytic or query tools preferred. Programming and coding experience preferred.
* Proven ability to handle data sources, filter and assess data quality, and recognize data patterns required. Strong problem-solving skills required.
* Excellent oral and written communication skills. Demonstrated self-motivation and initiative, as well as an ability to perform under pressure. Strong interpersonal skills. Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment.
* Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
* Support budget development process including forecasting and actual to budget comparison.
* Support development and forecasting of accruals for Finance and Accounting for various financial statement items.
* Provide analysis and reporting for financial and regulatory requirements including but not limited to MCR, ROI, product performance, provider and vendor relationships, and audit support.
* Perform actuarial analysis and modeling including but not limited to reserves, pricing, and forecasting.
* Develop ad hoc reports as a supplement to routine management reports through query building and data extraction.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $65,500 - $80,000 annually
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.