Claims Analyst jobs at System One - 37 jobs

About Us Wellington Management offers comprehensive investment management capabilities that span nearly all segments of the global capital markets. Our investment solutions, tailored to the unique return and risk objectives of institutional clients in more than 60 countries, draw on a robust body of proprietary research and a collaborative culture that encourages independent thought and healthy debate. As a private partnership, we believe our ownership structure fosters a long‑term view that aligns our perspectives with those of our clients. About the Role THE POSITION We are seeking a dynamic Relationship Analyst to join our Americas Institutional Group (AIG) team within the Client Platform Institutional Sales team, focusing on the Western US region. The Analyst, based in our San Francisco office, will work closely with Consultant Relations Managers, Business Developers, and Relationship Managers to deliver exceptional client service and to drive business development with our clients and consultants. RESPONSIBILITIES The RA will work closely with members of the AIG‑West team on a portfolio of assigned consultant and client accounts. Commanding a thorough knowledge of our business, and the interpersonal skills to deal effectively with institutional clients and consultants, they will conduct analysis on client accounts, initiate investigations, respond to inquiries on a variety of topics, and perform other tasks as appropriate. They will coordinate prospect reporting, presentations, account maintenance, and ad‑hoc requests, collaborating closely with our Product Management, Legal and Enterprise Risk, Finance, Portfolio Management, and Client Reporting teams. Primary responsibilities will include: Driving the preparation of high‑impact presentations of standard and/or customized client and prospect presentation materials, briefings, collateral materials, meeting notes, and follow‑ups required for external meetings Participating in client, consultant and prospect meetings and conference calls as appropriate Conducting analysis, initiating investigations and responding to internal and external ad‑hoc inquiries on a wide variety of topics, including portfolio and product specific information, investment guidelines, market trends, regulatory considerations, and fees Acting as a point of contact for various groups within consultant and client organizations Coordinating key client communications, acting as a trusted liaison between clients and internal teams Capturing and maintaining client data in relevant internal systems Collecting information to create and maintain a strong pipeline of prospects, including understanding the latest industry developments and uncovering potential business opportunities Qualifying and coordinating Requests for Information (RFI), Due Diligence Questionnaires (DDQ) and Requests for Proposals (RFP), working with internal teams to deliver comprehensive responses Developing an understanding of the depth and breadth of Wellington Management's investment approaches and those products most relevant to the institutional channel Championing data accuracy and insight‑driven reporting, leveraging the DMP (Delivery Management Platform) for client reporting, updating requirements on existing accounts and creating new templates during onboarding, working in close partnership with our Client Service Operations teams QUALIFICATIONS A successful candidate is likely to have the following qualifications: 2‑3 years of relevant client service experience, preferably within the Investment Management industry. Experience working with institutional clients and consultants is a plus Demonstrate a solid understanding of capital markets and/or investment products, coupled with intellectual curiosity Self‑motivated and proactive, with the ability to manage multiple projects efficiently. Thrives in a fast‑paced, collaborative environment as part of a global team, requiring focus, teamwork, and creativity Strong analytical skills, attention to detail, and organization Excellent communication, problem‑solving skills, and judgment Professional demeanor with maturity, presence, and a sense of humor A positive attitude and growth mindset, with flexibility and openness to learning and evolving Proficient in Microsoft Excel and Word; Salesforce experience preferred Bachelor's degree required; advanced degree or progress toward CAIA, CFA, or MBA preferred Career Development At Wellington Management, you won't just be starting a new job - you'll be launching a career at one of the world's largest and most respected active investment managers. With roots tracing back to 1928, we manage client solutions across equities, fixed income, hedge funds, and private markets. Our clients include some of the largest and most sophisticated institutional investors globally. Unparalleled exposure to global investment strategies and institutional client needs Hands‑on experience supporting business development and relationship management in one of the world's most dynamic financial hubs Mentorship and collaboration with seasoned professionals across investment, operations, and client service teams A front‑row seat to how investment decisions are communicated, structured, and supported for world‑class clients If you're driven, detail‑oriented, and excited to grow in a fast‑paced, global environment - we'd love to hear from you. Not sure you meet 100% of our qualifications? That's ok. If you believe that you could excel in this role, we encourage you to apply and welcome a chance to review your background. We are dedicated to building and maintaining a diversified workforce and considering a broad array of candidates with a variety of skill, workplace experiences, and backgrounds. As an equal opportunity employer, Wellington Management ensures that all qualified applicants will receive equal consideration for employment without regard to race, color, sex, sexual orientation, gender identity, gender expression, religion, creed, national origin, age, ancestry, disability (physical or mental), medical condition, citizenship, marital status, pregnancy, veteran or military status, genetic information or any other characteristic protected by applicable law. If you are a candidate with a disability, or are assisting a candidate with a disability, and require an accommodation to apply for one of our jobs, please email us at **********************************. Base salary is only one component of Wellington's total compensation approach. Other rewards may include a discretionary Corporate Bonus and/or Incentives, if eligible. In addition, we offer a comprehensive and high value benefit package to meet the unique needs of our employees and their families, and we are committed to fostering a flexible work environment that enables employees to thrive personally and professionally. USD 65,000 - 150,000 This range takes into account the wide range of factors that are considered when making compensation decisions, including but not limited to skill sets; role; skills and experience; certifications; and education. This range is an estimate, and further details on salary and total compensation aspects will be shared with candidates during the recruitment process. We believe that in person interactions inspire and energize our community and are essential to our culture. In support of this commitment, our employees work from our offices 4 days a week with flexibility to work remotely 1 day a week. We believe that this approach ultimately supports our mission to deliver investment excellence to our clients and their beneficiaries over the long term. #J-18808-Ljbffr

Calling all innovators and people ready to take a proactive approach to claims handling in a digital world!!! Slide is a cutting-edge Tampa-based insurtech company (have you seen us in the news lately?!) and we are looking for tech-savvy Claims professionals! Slide is an insurtech bringing together top talent, cutting-edge technology, world-class data science, and a human-centric approach. We work and think differently, leveraging Big Data, AI, and machine learning to simplify and hyper-personalize every part of the insurance process. Why? Because modern consumers expect and deserve more from the insurance experience. And we have what it takes to deliver it. Rebuilding every part of the insurance process to modernize the way it is written, explained, and managed is no small feat, but we are up for the challenge….are you? Job Summary: The position is responsible for the investigation, evaluation, negotiation, and settlement of personal lines property claims including dispute resolution and/or recovery. Duties and Responsibilities: Proactively communicate and set accurate claims expectations with customers throughout the Claims process while providing high quality customer service. Research, analyze, and interpret policy language and state law as it applies to submitted claims. Examine and appropriately interpret policies, forms, and other records to determine coverage and extent of company's exposure or liability. Appropriately apply knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations, and guidelines. Draft, approve, and adjust estimates of damage and loss amounts. Negotiate and settle claims in accordance with Slide's best practices, guidelines, and industry standards. Assign, direct, and monitor vendors conducting mitigation and/or other services during the adjustment process. Model ethical behavior and execute job responsibilities in accordance with Slide's core values, ethics, and information protection policies. Document all relevant information in the electronic claims management system. Contribute to the business production goals and objectives. Establish timely and appropriate claim reserves in accordance with claim standards. Appropriately represent the company by executing a high level of service and always maintaining professionalism. Perform other duties, as assigned. Education, Experience and Licensing Requirements: Bachelor's degree in a field with skills transferable to insurance preferred; HS Diploma required. Active Florida 6-20 Resident All Lines Adjuster License required. 3+ years of first-party property claims adjusting experience. 2+ years of experience working directly for a carrier Working knowledge of Florida insurance laws and Florida good faith claims handling experience. Technical savviness. Xactimate proficiency a plus Proficiency in Microsoft Windows environment. Industry designations or certifications a plus. Qualifications/Skills and Competencies: Excellent interpersonal and critical thinking skills. Data-driven, analytical approach necessary. Working knowledge to interpret and apply laws, rules, regulations, policies and procedures, and department operational guidelines in daily functions. Possesses strong customer service skills and can address customer escalations. Strong analytical, organizational, negotiation and communication skills. Ability to work independently, multi-task and adapt to frequent priority changes. Ability to plan, prioritize workload, organize, and coordinate multiple tasks and projects. Must possess excellent writing skills. Desire to live Slide's Core Values. What's in it for you?? A paycheck of course but really, much more! The Slide Vibe - An opportunity to be a part of a fun and innovation-driven Culture fueled by Passion, Purpose and Technology! Benefits - We have extensive and cost-effective benefits that cover you and your family from every angle... Physical Health, Emotional Health, Financial Health, Social Health, and Professional Health.

SummaCare - 1200 E Market St, Akron, OH Full-Time / 40 Hours / Days * Hybrid after training As a regional, provider-owned health plan, SummaCare values the relationship between the members and their doctors. SummaCare is a part of Summa Health, an integrated healthcare delivery system that includes Summa Health System hospitals, its community-based health centers, dedicated clinicians and SummaCare. Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits. Summary: Accurately and efficiently handles claims in accordance with regulatory and contractual guidelines. Reviews claims related to coordination of benefits, medical coding, and authorization allocation while ensuring compliance with established policies. Applies cost-containment strategies in collaboration with vendor partners to minimize claim expenses while adhering to plan-specific processing rules. are essential for success in this position. 1. Formal Education Required: a. High School Diploma or equivalent 2. Experience & Training Required: a. One (1) year experience to include any combination of the following: i. Health insurance claims processing ii. Health claims data entry including Document Management Services (DMS) iii. Customer service experience in a managed care environment iv. Physician or hospital billing v. Patient accounts Essential Functions: 1. Requires close attention to detail with independent judgment, decision making and problem solving skills necessary to complete the task being performed 2. Organizes reference materials for easy access; manages time to accurately complete tasks within time frames in a fast paced environment 3. Processes all types of claims, promptly and accurately, as assigned via the document management system, and ensures self-funded service standards, prompt pay standards, and regulatory requirements are met. 4. Maintains a working knowledge of the claims processing system, imaging system, key-stroke emulation system, code editing application, claims processing policies & procedures, and unique benefits/processing rules for self-funded, Medicare, MEWA, Marketplace and fully-insured plans. 5. Escalates questions or concerns to their mentor for evaluation and potential referral to the Claims Management staff for action plan and resolution 6. Meets or exceeds claims production and quality standards as established/communicated by Claims Management staff 7. Coordinates information and resolves service forms and other assignments promptly, in accordance with experience/capabilities. Handles special projects within timeframes established/assigned by supervisor 3. Other Skills, Competencies and Qualifications: a. Strong independent judgment and decision-making skills b. MS-windows based computer environment c. Medical terminology, CPT, HCPCs and ICD-10 knowledge d. Familiar with professional (CMS1500) and institutional (UB-04) claim types 4. Level of Physical Demands: a. Sit for prolonged periods of time b. Bend, stop and stretch c. Lift up to 20 pounds d. Manual dexterity to operate computer, phone and standard office machines Equal Opportunity Employer/Veterans/Disabled $19.23/hr - $23.08/hr The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical. Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits. * Basic Life and Accidental Death & Dismemberment (AD&D) * Supplemental Life and AD&D * Dependent Life Insurance * Short-Term and Long-Term Disability * Accident Insurance, Hospital Indemnity, and Critical Illness * Retirement Savings Plan * Flexible Spending Accounts - Healthcare and Dependent Care * Employee Assistance Program (EAP) * Identity Theft Protection * Pet Insurance * Education Assistance * Daily Pay

High school diploma or equivalent required. Minimum one year experience in claims processing or similar work environment, two years preferred. Technical degree or enrollment in technical/vocational program can substitute for years of experience. Ability to understand and effectively communicate concerning state, and federal child care food program policy. Strong communication, analytical and computation skills required. Able to work flexible hours including nights and weekends. Must have a valid Florida driver's license or State of Florida ID card. This is a position of special trust which requires the employee to successfully meet Level 2 Background screening requirements. Able to perform in an empowered environment by working collaboratively with other professionals, personnel and direct service providers. Must be familiar and comfortable working with diverse populations. ESSENTIAL JOB FUNCTIONS Enters claim, enrollment and eligibility data into database for monthly claim. Prepares and maintains required documents for assigned programs. Provides technical assistance as required to providers and Family Central, Inc. staff regarding assigned programs. Ensures that all required reports are completed accurately by assigned deadline. Prepares and mails monthly paper work to providers by assigned deadline. Assists with processing of monthly claims data for child care centers. Keeps manager and director informed of all tasks and projects. Assists manager and director with special projects. Participates in the organization of special events related to child care programs. Notice To Applicants This position requires background screening through the Florida Care Provider Background Screening Clearinghouse. For more information about background screening requirements, visit: ******************************** Family Central is an Affirmative Action/Equal Opportunity Employer, a Drug Free Workplace and requires drug testing.

Job Description High school diploma or equivalent required. Minimum one year experience in claims processing or similar work environment, two years preferred. Technical degree or enrollment in technical/vocational program can substitute for years of experience. Ability to understand and effectively communicate concerning state, and federal child care food program policy. Strong communication, analytical and computation skills required. Able to work flexible hours including nights and weekends. Must have a valid Florida driver's license or State of Florida ID card. This is a position of special trust which requires the employee to successfully meet Level 2 Background screening requirements. Able to perform in an empowered environment by working collaboratively with other professionals, personnel and direct service providers. Must be familiar and comfortable working with diverse populations. ESSENTIAL JOB FUNCTIONS Enters claim, enrollment and eligibility data into database for monthly claim. Prepares and maintains required documents for assigned programs. Provides technical assistance as required to providers and Family Central, Inc. staff regarding assigned programs. Ensures that all required reports are completed accurately by assigned deadline. Prepares and mails monthly paper work to providers by assigned deadline. Assists with processing of monthly claims data for child care centers. Keeps manager and director informed of all tasks and projects. Assists manager and director with special projects. Participates in the organization of special events related to child care programs. Notice To Applicants This position requires background screening through the Florida Care Provider Background Screening Clearinghouse. For more information about background screening requirements, visit: ******************************** Family Central is an Affirmative Action/Equal Opportunity Employer, a Drug Free Workplace and requires drug testing. Job Posted by ApplicantPro

Deep Roots. Solid Growth. Caring People. Rooted in Wyoming! We are Blue Cross Blue Shield Wyoming: a not-for-profit health insurer with offices throughout the state. Ever since a small group of caring, persistent Wyoming women helped us put down roots in 1945, everything we do is aimed at better health care for the people of Wyoming. Our Vision: We envision a future where integrity, compassion, and trust define a local health insurance experience. Committed to doing the right thing for our members, employees, and community, we strive to protect and contribute to the health and care of all we serve. Our Mission: provide our members with access to local health insurance solutions that prioritize health, care, and well-being for those who call Wyoming home. If our passion and purpose resonate with you, you may be who we are looking for. The role we are looking to fill: Claims Specialist If you are a passionate and detail-oriented professional looking to make a difference in the community, apply to be a BCBSWY Claims Specialist today. As a claims adjudicator you will be responsible for reviewing, assessing, and processing health plan claims to ensure accuracy, compliance with regulations, and adherence to company policies. In this role, you will key, review, evaluate, and process health plan claims received electronically and via mail. You'll collaborate with the Claims Management Team to ensure adjudication accuracy when needed. Our team approach requires interacting with other departments to solve problems and achieve common goals. To be successful, you must be able to navigate between multiple systems at the same time and communicate effectively in writing and verbally. You will also need to be well organized and detail oriented. Requirements include a high school, or equivalent, education and a willingness to help others. BCBSWY Employees Enjoy: Best-In-Class Health Insurance at minimal to no-cost for BCBSWY employees! PLUS many other benefits along with highly competitive compensation! Our compensation program is reviewed for competitive market match on an annual basis and employees are eligible for annual merit increases. Monthly incentives that are based on individual and company performance are also available to eligible employees and members of our Sales Team can realize generous performance-based commissions. At BCBSWY our employees are provided best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include medical, dental, vision, 401(k), life insurance, paid time off (PTO), 10 paid holidays in addition to PTO annually, plus 8 paid volunteer hours, various wellness programs, and a dress code of "Dress for Your Day!" which can mean jeans every day (depending on your role) . Serving Those Who Call Wyoming Home. Our positions are all based in Wyoming. Depending on the department and the position, eligible employees may be offered limited In-Office/WFH flexibility (for those positions that are offered limited WFH, there will be a required number of In-Office days per week/month depending on department). Executive level employees are required to reside full-time in Wyoming. Our Selection Process: Typically includes the following (NOTE: process steps may differ depending on role applied for) Review of your completed application and any additional submitted materials (e.g., cover letter, certifications, etc.) for minimum qualifications and skills alignment. Confirmation of Wyoming residency, intent to become a Wyoming resident, or reasonable commuter distance if Colorado resident. Recruiter Phone Screen. Possible Self-Assessment and/or Questionnaire. Initial interview with Hiring Manager. Possible 2nd Interview with Hiring Manager and/or additional Team members. Comprehensive Background Check. BCBSWY is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. Qualified applicants are provided with an equal opportunity and selection decisions are based on job-related factors. We use E-Verify to confirm employment eligibility; we DO NOT sponsor applicants for work visas. BCBSWY is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided reasonable accommodations for the application, selection, and hiring process. If reasonable accommodation is needed, please contact: *************

Investigates, determines liability, confirm coverage, establishes damages, and negotiates settlement of auto, property and light general liability claims for a Member based organization in accordance with approved policy & procedure and industry Best Practices. This position does not handle injury, complex or litigated claims. RESPONSIBILITIES AND DUTIES: Responsible for the investigation of assigned auto, non-complex general liability, and first-party property cases in compliance with prescribed industry best practices. This includes verifying coverage, determining liability, evaluating damages, establishing reserves, reporting status, and negotiating appropriate settlements for each claim. Possesses a certain level of financial authority to settle independently. Maintains an appropriate diary and documentation as to file activity. Makes determination and handles files with subrogation potential. Works with Independent Appraisers to estimate the cost of repair or replacement of damaged or stolen vehicles / damaged property. Reports theft, fraud, and arson losses as required to state and industry agencies, as appropriate. Performs most duties on an individual basis, and work has a direct bearing on Management results. Represents the Company from a public relations standpoint and must conduct oneself appropriately at all times. Personal contacts are a major part of activity and include Members, claimants, witnesses, vendors, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses and all other person's incident to the investigation and processing of claims. Attends required or necessary training sessions, courses to maintain their license credits and to maintain up to date knowledge & skills. Performs other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: Excellent negotiation, analytical and interpretive skills Excellent oral, written communication and presentation skills Strong organizational and interpersonal skills Superior customer service skills Able to multitask and set own priorities Works well under pressure Should be used to and able to function effectively in a fast-paced environment. Able to establish and maintain effective working relationships with department heads, managers, employees, and vendors. Government claims background is a plus. Physical Requirements include: Bending, Pulling, Sorting, Carrying up to 20 lbs., Pushing, Speaking (English), Climbing, Reaching, Standing, Key entering, Reading (English), Walking, Kneeling, Seeing, Writing (English) Should be able to type 35 WPM. Spanish fluency is a plus. TRAINING AND EXPERIENCE: Position requires a degree from an accredited College/University in business or insurance preferred or equivalent experience in industry. One to three years of experience in insurance industry as a Customer Service Representative or Property or Auto Liability (no injury) adjuster. Knowledge of Microsoft Office products a must. Must have an active Florida Adjusters License. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. **PLEASE DO NOT APPLY IF YOU ARE A SMOKER** Classification: Exempt Dept: Property & Liability Reports to: Claims Supervisor

Take on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the auditor. You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures. You will: + Research over and under-payment inquiries/appeals + Compile and maintain statistical data consistent + Maintain departmental production and quality standards Salary Range: $31.51 - $62.64 HourlyQualifications We're seeking a self-motivated, detail-oriented, deadline-driven individual with: + High school diploma, GED or equivalent + Four or more years of medical claims payment experience in an HMO environment + Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS + Understanding of Medicare Guidelines and COB + Knowledge of medical terminology + Experience in benefit determination and claims adjudication + Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM + Understanding of professional and facility reimbursement methodologies + Strong organizational skills + Computer proficiency with Microsoft Office + Knowledge of claims adjudication systems + Flexibility and adaptability UCLA Health is a world-renowned health system with four award-winning hospitals and more than 250 community clinics throughout Southern California. We are also home to the David Geffen School of Medicine, a highly respected leader in the development of breakthrough medical research and outstanding clinical professionals. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health. UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person's unique achievements and experiences to further set us apart.

Family Central, Inc. contracts with the Florida Department of Health as a sponsor for the USDA Child Care Food Program to sponsor licensed family child care homes in Broward, Miami-Dade and Palm Beach counties and child care centers in Broward, Miami-Dade, Palm Beach, Martin and St. Lucie counties. The goal of this valuable program is to ensure that nutritious meals and snacks are served and that good eating habits are taught in child care settings. We assist childcare facilities in implementing "best practices" to ensure children have access to a variety of nutritious foods which leads to healthy growth and reducing obesity risk. We have an opening in our Fort Lauderdale location for a Childcare Food Program Claims Rep. In this position, you will be responsible for: * Entering claim, enrollment and eligibility data into database for monthly claim. * Preparing and maintaining required documents for assigned programs. * Providing technical assistance as required to childcare providers and Family Central, Inc. staff regarding assigned programs. * Ensuring that all required reports are completed accurately by assigned deadline. * Preparing and mailing monthly paper work to providers by assigned deadline. * Assisting with processing of monthly claims data for child care centers. * Keeping manager and Chief Program Officer informed of all tasks and projects and assisting with projects as needed. * Participating in the organization of special events related to child care programs. * Performing other duties that are necessary for the success of the department and to meet accreditation standards. In order to be considered for this position, here are our requirements: * High school diploma or equivalent required. Minimum one year experience in claims processing or similar work environment, two years preferred. Technical degree or enrollment in technical/vocational program can substitute for years of experience. * Ability to understand and effectively communicate concerning state, and federal child care food program policy. * Strong communication, analytical and computation skills required. * Able to work flexible hours including nights and weekends as needed. * Must have a valid Florida driver's license or State of Florida ID card. * This is a position of special trust which requires the employee to successfully meet Level 2 Background screening requirements. * Able to perform in an empowered environment by working collaboratively with other professionals, personnel and direct service providers. Must be familiar and comfortable working with diverse populations. Consider joining a company with great benefits, great working environment and great team that have fun while working! Notice To Applicants This position requires background screening through the Florida Care Provider Background Screening Clearinghouse. For more information about background screening requirements, visit: ******************************** Family Central is an Affirmative Action/Equal Opportunity Employer, a Drug Free Workplace and requires drug testing.

, here are our requirements: High school diploma or equivalent required. Minimum one year experience in claims processing or similar work environment, two years preferred. Technical degree or enrollment in technical/vocational program can substitute for years of experience. Ability to understand and effectively communicate concerning state, and federal child care food program policy. Strong communication, analytical and computation skills required. Able to work flexible hours including nights and weekends as needed. Must have a valid Florida driver's license or State of Florida ID card. This is a position of special trust which requires the employee to successfully meet Level 2 Background screening requirements. Able to perform in an empowered environment by working collaboratively with other professionals, personnel and direct service providers. Must be familiar and comfortable working with diverse populations. Consider joining a company with great benefits, great working environment and great team that have fun while working! Notice To Applicants This position requires background screening through the Florida Care Provider Background Screening Clearinghouse. For more information about background screening requirements, visit: ******************************** Family Central is an Affirmative Action/Equal Opportunity Employer, a Drug Free Workplace and requires drug testing.

Easterseals is leading the way to full equity, inclusion and access through life-changing disability and community services. For more than 100 years, we have worked tirelessly with our partners to enhance quality of life and expand local access to healthcare, education and employment opportunities. Easterseals Southern California provides essential services and on-the-ground supports to more than 15,000 people each year-from early childhood programs for the critical first five years, to autism services, daily and independent living services for adults, employment programs, veterans' services and more. Our public education, policy and advocacy initiatives positively shape perceptions and address the urgent and evolving needs of the one in four Americans with disabilities today. Together, we're empowering people with disabilities, families and communities to be full and equal participants in society. Join us as we seek to be the most inclusive place for people with disabilities to live, learn, work & play easterseals.com/southerncal Hiring range: 70k-80k/yr OVERVIEW OF POSITION: Represents the user interface functionality, system configuration, and workflow of the Electronic Health Records (EHR) system; and collaborates with treatment providers to manage division-wide user interface design and implementation. Evaluates EHR data to recommend process improvements. Responds to inquiries related to EHR. Abstracts, evaluates, and distributes health data and reports to support processes and activities of designated teams. Works in coordination with internal IT support teams and external EHR system vendor. ESSENTIAL FUNCTION: Identifies issues that arise in assigned application area as well as issues that impact other application teams. Manages all inquiries and concerns related to Electronic Health Records (EHR) system from the vendor network as well as the internal function. Acts as primary point of contact for Information Technology department for EHR testing and further development of the system related to Provider Network and internal function. Provides subject matter expertise in system upgrade planning and design. Ensures the proper usage or the EHR System and provides end-users ongoing training during all phases of implementation and operation of the system. Serves as a liaison between end users' workflow needs and EHR support staff. Develops training materials as required. Analyzes and interprets EHR system data for use in Provider Network and internal function operations to ensure the highest level of efficiency and drive continuous process improvements. Works closely with the internal function leaders to evaluate data, analyze trends, and make recommendations. Creates, reviews, and maintains regularly scheduled data distribution reports. May gather data from multiple sources. May prepare and submit data/reports to comply with reporting obligations with external organizations. Prepares and submits timely and accurately documents/forms/data/reports as assigned. Works cross-functionally with internal departments and/or external entities, on data distribution activities related to assigned team/department; providing and receiving information, coordinating and/or facilitating activities. Provides project support and participates in the continuous quality improvement processes of the supported teams as assigned, related to health records. Assists with the maintenance and updating of related policies and procedures as required. Communicates in a timely manner when data or resources are unavailable to internal and outside entities. Performs other duties as assigned, which may include administrative related support to the service line, overseeing and supporting administrative assistants in gathering, distributing, and communicating data related to business needs, providing supervision to adminstrative assistants to support them in completing tasks related to analytics, scorecards, reports, and other resources. EDUCATION: Bachelor's degree in Health Services or related field subject preferred.|Certifications such as Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) preferred. EXPERIENCE: 3+ years of recent experience of electronic health record management and training to users. KNOWLEDGE, SKILLS, ABILITIES: Knowledge of electronic health record processes; such as, record storage and retrieval, record retention, workflow, authentication and documentation standardization. Ability to establish and maintain various data collection, record keeping, tracking, filing, and reporting systems. Ability to maintain current knowledge of local, state and federal laws and regulations regarding the management of EHR client information. Ability to assess the training needs of staff and develop appropriate training programs. Highly Proficient in Microsoft Office (Word, Excel, Outlook), web-based applications, databases, internet usage, and Electronic Health Records (EHR) software. Excellent organizational, decision-making, time management, oral and written communication skills. Ability to communicate effectively with all levels of associates, physician's office personnel, vendors, external organizations, and the general public. Knowledge preferred of clinical and business needs and processes within health care organizations. Ability to assist in efficient office operations. Ability to maintain customer-service orientation and professionalism in all interactions. Ability to exercise discretion and confidentiality pertaining to work environment. Ability to prioritize and organize workload and be able to produce high-quality results with meticulous attention to detail. Ability to maintain a high level of accuracy and completeness in all work. Ability to remain focused and flexible while shifting/changing priorities, heavy workload, and tight deadlines. Able to support multiple teams/departments simultaneously. Ability to acquire an understanding of organization and department policies and practices. Ability to work with minimum supervision within established guidelines and procedures, as a team member and as an individual contributor. Ability to obtain and maintain a criminal record/fingerprint clearance from the Department of Justice and Federal Bureau of Investigation per Easterseals Southern California and/or program requirements. Ability to travel locally to between various ESSC locations, with own reliable transportation; maintain driving record in compliance with Transportation Safety Standards, maintain auto insurance and vehicle registration. Ability to pass all drug testing required by ESSC. Carrying/Lifting: Occasional / 0-30 lbs. Standing: Occasional / Up to 3 hours per day Sitting: Constant / Up to 8 hours per day Walking: Occasional / Up to 3 hours per day Repetitive Motion/Activity: Keyboard activity, telephone use, writing Visual Acuity: Ability to view computer monitor and read newsprint Travel: Up to 30% of time Environmental Exposure: Frequent exposure to unpleasant or hazardous working conditions (noise, heat, dust, bodily fluids, etc.) 20-50% of work time.

Job DescriptionJob ProfileJob TitleWorkers Compensation Claims Examiner (1360552) LocationRemote/Hybrid in San Diego CAHire TypeContingentHourlyopenWork ModelMonday - FridayContact Phone(443)-345-3305 Contact Emailsean@marykraft.com Nature & Scope:Positional Overview Mary Kraft is seeking an experienced Workers Compensation Claims Examiner to analyze complex or technically difficult workers' compensation claims. The role involves managing high-exposure claims, including those with litigation and rehabilitation, ensuring adherence to industry best practices, service expectations, and specific client requirements. The examiner will also identify subrogation opportunities and negotiate settlements to achieve cost-effective resolutions.Role & Responsibility:Tasks That Will Lead To Your Success Analyze and process complex workers' compensation claims by investigating and gathering information to determine the exposure on the claim. Manage claims through well-developed action plans, ensuring timely and appropriate resolutions. Negotiate settlement of claims within designated authority limits. Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim. Approve and process claim payments, adjustments, and benefits, ensuring accuracy and timeliness. Prepare necessary state filings within statutory limits. Oversee the litigation process to ensure timely and cost-effective resolution of claims. Coordinate vendor referrals for additional investigation or litigation management. Implement cost-containment strategies, including partnerships with vendors, to reduce overall claim costs. Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets. Report claims to excess carriers and respond to their inquiries in a timely and professional manner. Maintain communication with claimants and clients, fostering professional relationships. Ensure claims files are properly documented, with accurate coding. Refer complex cases to supervisors or management as needed. Skills & Experience:Qualifications That Will Help You Thrive Bachelor's degree from an accredited college or university preferred. Professional certifications relevant to workers' compensation claims are preferred. Five (5) years of claims management experience or an equivalent combination of education and experience required. Minimum of 3 years of California workers' compensation claims handling experience is mandatory. Self-Insurance Plan (SIP) certification is preferred but not mandatory. Expertise in insurance principles and laws, claim and disability duration, and medical management practices. Strong knowledge of Social Security, Medicare application procedures, and recovery processes. Excellent communication skills, both oral and written, including presentation abilities. Proficiency in Microsoft Office and general PC literacy. Strong analytical, interpretive, and problem-solving skills. Strong organizational skills and the ability to manage multiple priorities effectively. Excellent negotiation skills. Ability to work collaboratively in a team environment and meet or exceed service expectations.

The Conference Payment Analyst will play a key role in supporting IEEE's Conferences, Events, and Experiences department by ensuring the accurate and compliant processing of event-related payments. This position requires meticulous attention to detail in reviewing and approving payments to vendors, speakers, awardees, and other stakeholders involved in IEEE conferences. The Conference Payment Analyst will ensure that all payment requests are supported by appropriate documentation and are compliant with company policies, tax regulations, and best business practices. The role also involves substantial communication with conference organizers to provide updates on payment status and guide them in resolving documentation issues. Bachelor's degree in Business, Finance, or a related field Proven experience in payment processing, financial administration, or a similar role Ability to understand compliance, tax regulations, and financial best practices Excellent organizational skills and attention to detail Strong communication skills with the ability to collaborate with internal and external stakeholders Familiarity with financial software and payment systems Ability to handle sensitive information with discretion and maintain confidentiality. Salary Range: * $30-$36/hr

Temporary Conference Payment Analyst - 250309: N/A Description The Conference Payment Analyst will play a key role in supporting IEEE's Conferences, Events, and Experiences department by ensuring the accurate and compliant processing of event-related payments. This position requires meticulous attention to detail in reviewing and approving payments to vendors, speakers, awardees, and other stakeholders involved in IEEE conferences. The Conference Payment Analyst will ensure that all payment requests are supported by appropriate documentation and are compliant with company policies, tax regulations, and best business practices. The role also involves substantial communication with conference organizers to provide updates on payment status and guide them in resolving documentation issues. Qualifications Bachelor's degree in Business, Finance, or a related field Proven experience in payment processing, financial administration, or a similar role Ability to understand compliance, tax regulations, and financial best practices Excellent organizational skills and attention to detail Strong communication skills with the ability to collaborate with internal and external stakeholders Familiarity with financial software and payment systems Ability to handle sensitive information with discretion and maintain confidentiality. Salary Range: $30-$36/hr Job: Meeting & Event Management Primary Location: United States-New Jersey-Piscataway Schedule: Full-time Job Type: Temporary Job Posting: Dec 11, 2025, 8:16:15 PM

Become a champion of hope. At Rosecrance, we've been leading the way in behavioral health services for over a century. Our team empowers individuals and families to overcome substance use and mental health challenges through compassionate care and evidence-based therapies. If you're ready to make a meaningful impact, we're ready to welcome you! We are looking for dedicated individuals to join our team and help deliver on our mission of hope and recovery. Position Purpose: The High Impact Claims Specialist will serve as a primary resource to identify high dollar collection issues with our commercial payors, increase revenue and track and trend payor collection issues. This role will work closely with management to support the A/R team's collection efforts. Qualifications/Basic Job Requirements: • High School diploma or GED • Minimum of ten years' experience in researching and solving high dollar complex insurance claims and denials. • Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel. • Adequate written skills to accurately complete required documentation within the time frames prescribed • Excellent organizational and customer service skills • Must be emotionally and medically able to perform essential job responsibilities • Must be free from active or infectious diseases Essential Responsibilities: 1. Review and process all BC/BS and Commercial high dollar claims (over $10,000) for denials, payor issues and payment trends. 2. Submit, process and track all appeals for BC/BS and commercial payors. Maintain knowledge of ERISA laws governing employee benefit plans and manage the appeal process for these claims. 3. Assist A/R staff with complex claim issues they are unable to resolve in a timely manner. 4. Track and trend all Single Case Agreements. Work closely with Contracting on any SCA payment issues / concerns. 5. Review payments for BC/BS and commercial payors for rate validation according to our contracts. 6. Track all denial outcomes for payment, write-offs and transfers to client liability. Identify the root cause for the adjustments to client accounts. Work with management to review adjustment trends and identify potential solutions. 7. Help maintain integrity of accounts receivable ledger, including aged receivable monitoring on an ongoing basis. 8. Responsible for maintaining current knowledge of revenue components including benefit plans, contract terms and rates and billing forms and codes. 9. Check status of claims through use of telephone, websites and/or other means available. 10. Document adjustments needed to patient accounts. 11. As needed, participate in phone conference calls with payors. 12. Pursue collection activities and follow up for balances outside of established norms. 13. Coordinate collection activities with outside agencies, including court appearances, as needed. 14. Provide feedback & education management with regards to issues that impact revenue flow. 15. Provide appropriate documentation and reports designed to assist in fiscal management of the agency. 16. Serve as a member of the SWAT Team and participate in team meetings. 17. Serve as a member of the Revenue Cycle Team and participate in all team meetings and activities. 18. Understand and comply with all of the principles established by the Rosecrance Corporate Compliance Program and Code of Ethics. 19. Perform all responsibilities in compliance with the mission, vision, values and expectations of Rosecrance. 20. Deliver exceptional customer service consistently to every customer. 21. Serve as a role model for other staff, clients and customers and demonstrate positive guest relations in representing Rosecrance. 22. Assume other related responsibilities as assigned by management. Physical Requirements/Percentage of Work Time: 1. Vision: Must be able to read printed and/or handwritten materials from a variety of sources 75-100% 2. Hearing: Must be able to hear well enough to communicate with coworkers 50-79%; answer incoming phone calls 25-49%; interact with the public 25-49% 3. Standing/Walking/Mobility: Must have mobility between departments within the facility 25-49% 4. Climbing/Stooping/Kneeling: 0-24% 5. Lifting/Pulling/Pushing: Must exert up to 20 pounds of force occasionally and/or up to 5 pounds of force frequently to lift or move objects 25-49% 6. Fingering/Grasping/Feeling: Must be able to finger keyboard for computer work and phone equipment for placing/receiving calls 50-74% 7. Sitting: must be able to sit for prolonged periods of time when using the computer 25-49% Environment: Exposure to bloodborne pathogens requiring the use of universal precautions and/or personal protective equipment. Exposure to computers. Schedule: `8-hour shifts Friday-Monday 830a-5p Compensation & Rewards Based on education, experience, and credentials Starting pay - $22.47/hr Work Location: Remote-Rockford, IL Our Benefits Rosecrance values its employees and offers a comprehensive benefits package for you and your family: Medical, dental, and vision insurance (multiple plan options to meet your needs) 401(k) with employer match & discretionary contribution Group Life Insurance, LTD and AD&D Tuition assistance & licensure/certification reimbursement Paid Time Off, sick time, bereavement leave Referral program earning up to $1,000 per hire! Wellness program, including an on-site gym at select facilities Discounts at participating retailers Daily pay available through UKG Wallet for financial flexibility Who We Are Rosecrance has been at the forefront of providing behavioral health services for over a century. Our mission is to empower individuals and families to overcome substance abuse and mental health challenges through evidence-based therapies and compassionate care. Join us in our mission to foster lasting recovery and transform lives. We are committed to providing careers that make a difference in the lives of the people we serve and the people we employ. We do this through the work we do, our core mission and values, our employee resources, and especially through our purpose-driven community of opportunity and hope. Our Health and Safety Commitment We maintain a zero-tolerance drug-free environment, including marijuana, to prioritize safety for staff and clients. All candidates must pass an occupational health screening, ensuring a secure and healthy workplace. Equal Employment Opportunity Rosecrance is an equal opportunity employer and values diversity in the workplace. We do not discriminate based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, marital status, veteran status, or any other legally protected status. Our hiring decisions are based solely on qualifications, skills, and experience relevant to the requirements of the position. Our Partnerships AARP Employer Pledge Program MSEP (Military Spouse Employment Partnership). Ready to Make a Difference? Apply today and be part o

The OpportunityThe Growth Analyst will be responsible for marketing data analysis to identify market trends, synthesize our consumer behavior, and uncover meaningful insights to inform business strategies for Everyday Health Consumer brands such as Everyday Health, Migraine Again, and DailyOM. This individual will move beyond simple reporting to develop deep, actionable insights that inform marketing strategy, optimize campaign performance, and uncover new revenue opportunities across our core marketing channels (email, web, content syndication, and partnerships). The role requires a curious, proactive, and meticulous individual with exceptional quantitative skills and the ability to translate complex data into clear and compelling narratives. Working within a data-focused company, this individual will work with and learn from data experts across BI, Product, and other research teams, all with the goal of supporting our mission to inspire and enable people to live their healthiest lives every day.Key Responsibilities● Serve as the primary analytical partner to the Marketing and Content teams, embedding data-driven insights into their planning, content creation, and execution workflows.● Develop and maintain executive-level dashboards and reports focused on core marketing KPIs, ensuring data integrity and clarity. Act as the subject matter expert for marketing data structures, ensuring consistent tracking, definition, and usage of metrics across the marketing organization.● Conduct complex quantitative and qualitative analyses on marketing performance data to identify root causes, trends, and future growth drivers.● Analyze user data to map end-to-end customer journeys, identifying key friction points and opportunities for personalization and optimization within the lifecycle and content consumption experience.● Partner with the Marketing teams to define and prioritize the most impactful A/B testing hypotheses, analyze results, and synthesize learnings into documented best practices.● Collaborate with the Marketing and BI teams to support marketing forecasting, budget planning, and predictive modeling initiatives.● Monitor the competitive landscape, analyzing marketing strategies, messaging, and product features of key competitors to inform Everyday Health's strategic positioning. Job Qualifications● Proven: You have 4+ years of experience in a Growth Analyst, Marketing Analyst, Business Intelligence, or Insights role, preferably within a B2C, media, or subscription-based digital business. You have a strong understanding of digital marketing metrics, including CPA, LTV, ROI, conversion rates, email metrics, and web analytics. Experience with Google Analytics, SQL, a data visualization tools is required (Lookerstudio, Domo).● Analytics-obsessed: You're a connector of dots. People know you as the go-to data whisperer. You're able to look at a massive spreadsheet and unpack it for truth, using your exceptionally strong analytical and quantitative skills to guide teams on impactful decisions.● Collaborative: You're a cross-functional team player with strong project management and leadership skills, working with an eagle eye for detail and a contagious energy. You run to - not from - a challenge, managing multiple projects, setting priorities and meeting deadlines. About Everyday HealthEveryday Health Group (EHG) is a recognized leader in patient and provider education and services attracting an engaged audience of over 74 million health consumers and over 890,000 U.S. practicing physicians and clinicians. Our mission is to drive better clinical and health outcomes through decision-making informed by highly relevant information, data, and analytics. We empower healthcare providers, consumers and payers with trusted content and services delivered through Everyday Health Group's world-class brands. Life at Everyday HealthAt Everyday Health Group, the Health & Wellness division of Ziff Davis, we work in a culture of collaboration and welcome those who desire to join our growing global community. We believe in careers versus jobs and people versus employees. We seek enthusiastic individuals with an entrepreneurial spirit looking for an environment that rewards your best work. Our Culture and ValuesWe created our values together to guide our collective purpose and pursuits. We are collaborators and problem solvers. We empower one another to make informed decisions and to be enabled towards action. We embrace success. We recognize that innovation can spark and be born from any of us no matter our individual role or background. We encourage open mindedness and sensitivity to each other and our environment. Our personal and professional passions get ignited, nurtured and supported. We value that doing is greater than talking as the most measurable means of impact. Our collective purpose to deliver enlightened audience experiences with trusted brands is what drives the success of our business and our professional satisfaction. About Ziff DavisZiff Davis (NASDAQ: ZD) is a vertically focused digital media and internet company whose portfolio includes leading brands in technology, shopping, gaming and entertainment, connectivity, health, cybersecurity, and martech. Today, Ziff Davis is focused on seven key verticals - Technology, Connectivity, Shopping, Entertainment, Health & Wellness, Cybersecurity and Marketing Technology. Its brands include IGN, Mashable, RetailMeNot, PCMag, Humble Bundle, Spiceworks, Ookla (Speedtest), RootMetrics, Everyday Health, BabyCenter, Moz, iContact and Vipre Security.At Ziff Davis & Everyday Health Group, we remain dedicated to creating an environment where everyone feels valued, respected and empowered to succeed. We offer Employee Resource Groups, company-sponsored events, and regular opportunities for professional growth through educational support, mentorship programs and career development resources. Our employees are recognized and celebrated through employee engagement programs and recognition awards.Ziff Davis is an Equal Opportunity Employer. At Ziff Davis, Diversity, Equity and Inclusion has always been about fairness, equal opportunity and belonging, which enables us to attract and retain the best talent, regardless of background or circumstances, allowing our thousands of employees worldwide to thrive . The Company provides a range for the base pay. Factors that may be used to determine your actual pay may include your specific job related knowledge, skills, experience and geographic location. The salary compensation for this role is $80,000 - $100,000. Individual pay within the compensation range for this business unit specific role is determined based on a variety of factors including experience, scope of the role, capabilities to perform the role, education and training, as well as business and company performance. If you're seeking a dynamic and collaborative work environment where you can see the direct impact of your performance and thrive both personally and professionally, then Everyday Health Group is the place for you. Everyday Health Group has employees located in 40+ states as well as offices in NYC, Asheville, Boston, London, England and Mumbai, India. #everydayhealth

We know there is someone out there that will make an excellent addition to our team. Someone who gets along well with others, is thorough and efficient, can follow company procedures, is able to multi-task and has amazing customer service. Our clinic is a dynamic place to work, practice, and grow. We have 4 primary care health centers and deliver integrated services including Medical, Behavioral Health, Pharmacy, Dental, Optometry, specialty referrals, chronic disease management, health education, and much, much more. * Location: Utah Navajo Health System, Inc. * Full-time Benefits include: Health Insurance, 5% of gross to a 403b retirement account, life insurance, Vacation leave, PTO leave, Holiday pay, Short/Long term disability, wellness benefit * Wage depends on experience Tasks * Develop systems and processes to limit program liabilities and provide proper audits to identify risk and prevent duplicate discounts and diversion. * Review and monitor 340B Program policies and procedures on an ongoing basis and offer contributions and changes to ensure 340B compliance. * Provide proactive education to staff on policies and procedures related to 340B program management and procedures. * Manage any and all 340B external audits. * Monitor and audit state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates. * Ensure that company maintains adherence to 340B Program regulations and guidelines. * Perform audits on a scheduled basis; may involve presenting and resolving reconciliation issues as they arise during the monitoring and reconciliation process. * Assess opportunities for cost savings and system improvements to yield higher compliance. * Develop a thorough understanding of the 340B Program. Strive to consistently improve the overall efficiency, value, and internal support of the 340B Program. * Develop reports that can be used to educate staff and assist management in tracking the overall financial impact to the organization. Build other reports, as appropriate, to monitor and improve 340B Program compliance and performance. * Collaborate with the Pharmacy department, Compliance Committee, and Finance department to develop monthly, quarterly, and yearly audit and financial metrics. * Summarize results and provide reporting to the appropriate internal and external entities. * Other compliance and financial duties as assigned. Requirements * BA/BS degree in accounting, finance, business, or other quantitative background. * 5 or more years of progressive, financial or analytical experience, highly preferably in a healthcare setting. * Excellent data analysis skills with the demonstrated ability to act on analysis results. * Ability to work independently while managing multiple tasks and meeting established deadlines. * Strong working knowledge and/or experience with Microsoft Office products Excel, Word, PowerPoint, relational databases, and other analytical tools. * Prior pharmacy experience preferred. UNHS would not be able to achieve our goal of quality equitable healthcare for people living in Southeastern Utah without our committed and competent staff. UNHS continually attracts the most devoted healthcare professionals and administrators this region has to offer. We offer the opportunity to work with a dynamic team providing care to medically under-served communities.UNHS hires in accordance with NPEA and EEOC standards.

Requirements BA/BS degree in accounting, finance, business, or other quantitative background. 5 or more years of progressive, financial or analytical experience, highly preferably in a healthcare setting. Excellent data analysis skills with the demonstrated ability to act on analysis results. Ability to work independently while managing multiple tasks and meeting established deadlines. Strong working knowledge and/or experience with Microsoft Office products Excel, Word, PowerPoint, relational databases, and other analytical tools. Prior pharmacy experience preferred. UNHS would not be able to achieve our goal of quality equitable healthcare for people living in Southeastern Utah without our committed and competent staff. UNHS continually attracts the most devoted healthcare professionals and administrators this region has to offer. We offer the opportunity to work with a dynamic team providing care to medically under-served communities. UNHS hires in accordance with NPEA and EEOC standards.

This analyst works within the UM/UR and Crisis Departments. This person is responsible for providing clinical oversight, advocacy, and authorization for individuals being assessed for higher levels of care. The Analyst will complete retrospective reviews, specialist reviews and is also responsible for promoting appropriate, effective, and efficient use of resources via initial authorizations and concurrent reviews of acute care authorizations. Essential Functions Assess verification of insurance, county of financial responsibility (COFR), and ensure that acute care criteria guidelines have been met. Provide timely and comprehensive analysis of acute care initial authorizations according to established clinical protocols and diagnostic criteria. Assist individuals in accessing necessary crisis services as medically appropriate and in the least restrictive environment. Leverages clinical knowledge, business rules, regulatory guidelines, policies and procedures to determine clinical appropriateness for acute care authorizations. Support strategies to comply with state, federal, CARF, NCQA, and HEDIS regulations/initiatives. Provide support to community partners and network staff related to acute services and best practices. Determines clinical appropriateness for Specialist Reviews and Specialist Approvals. Conducts concurrent clinical case reviews as requested and provides recommendations for follow up. Conducts retrospective reviews of service provision to ensure services were provided in the appropriate amount, scope, and duration to reasonably achieve goals as outlined in the Individualized Plan of Service. Utilizes knowledge of protocols and audit tools to conduct clinical audits and ensures inter-rater reliability within timeframes outlined. Conducts retrospective reviews for acute care admissions utilizing the MCG Parity Tool and completes comprehensive reviews of acute care admissions. Reviews and contributes to the development and continuous updating of protocols, audit tools, procedures, and processes within the Utilization Management department. Additional duties as assigned. Job Requirements and Qualifications Education : Master's degree in relevant discipline required. Training Requirements (licenses, programs, or certificates): State of Michigan license, certification and / or registration as, Psychologist (LLP, LP), Social Worker (LMSW), Counselor (LPC), Marriage and Family Therapist (LMFT) or Nurse (RN). For children's services - maintain/attain 24 hours annually of child-specific training (Child Diagnostic and Treatment Professional). Experience Requirements: Minimum of two years' experience working in the human health and service field. Preferred Experience: Experience in working with electronic health records Prior experience working in a crisis or psychiatric hospital service environment (hospital, crisis center, community mental health agency, ACT team) Experience with data entry Experience working with adults with severe mental illness, substance use disorder or intellectual/developmental disabilities Experience working with children with serious emotional disturbance Job Specific Competencies/Skills: Demonstrates effective interpersonal skills. Demonstrates ability to work effectively in a team environment. Demonstrates effective negotiation skills. Demonstrates effective written and oral communication skills. Demonstrates effective computer skills. Demonstrates effective project management/organizational skills. Demonstrates effective de-escalation and problem-solving skills Knowledge Requirements: Knowledge of medically necessary criteria for acute care behavioral health treatment Knowledge of the Michigan Mental Health Code, HIPPA, Medicaid Provider Manual Knowledge of the clinical care process-crisis continuum (screening, crisis assessment, treatment planning, case management and continuing care) Knowledge of the practices and principles of psychological, emotional, and social assessment and diagnosis Oakland Community Health Network's Core Competencies: Interacting with others in a way that gives them confidence in one's intentions and those of the organization; demonstrating loyalty to the organization and its mission and values; maintaining social, ethical, and organizational norms; firmly adhering to codes of conduct and ethical principles. (Integrity/Building Trust) Making individuals and their needs a primary focus of one's actions; developing and sustaining productive relationships, recognizing that the individual is the person served. (Individual Focus) Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application. (Continuous Learning) Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence in addition to consciously adopting organizational standards of excellence. (Work Standards) Clearly conveying information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message. (Communication) Additional Information ( Travel required, physical requirements, etc.): Must have available means of transportation to and from OCHN. All shifts are virtual Must be available for meetings and events which may occur outside of standard office hours. The ideal candidate must be able to complete all physical requirements of the job with or without reasonable accommodation. OCHN is committed to building a diverse team and fostering an inclusive and equitable culture. We are proud to be an equal opportunity employer that embraces and encourages our employees' differences. This includes (but is not limited to) ability, age, color, family type, gender expression and identity, individual expression, medical conditions, national origin, pregnancy, race, religion, sexual orientation, veteran status, and all other diverse and wonderful characteristics.