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The Plymouth Rock Company Incorporated jobs in Philadelphia, PA - 8365 jobs

  • Customer Service Associate

    Plymouth Rock 4.7company rating

    Plymouth Rock job in Fort Washington, PA

    Are you ready to embark on a rewarding career journey? At Plymouth Rock, we pride ourselves on fostering a dynamic and supportive service center environment where professionalism and teamwork are highly valued. If you're the kind of person who enjoys solving problems and helping others when they need it, this could be a great opportunity to start your career at Plymouth Rock! We're currently seeking passionate individuals to join our team as Customer Service Associate, where you'll play a pivotal role in providing exceptional service to our valued customers, agents, and partners. As a Customer Service Associate, you'll be at the forefront of our customer interactions, handling inbound calls with efficiency and professionalism. With our internal paid training and licensing program, you will become a certified subject matter expert on Plymouth Rock and affiliate insurance products. RESPONSIBILITIES * Answer inquiries via phone, email and texting regarding policies, coverages, and premiums with confidence and accuracy. * Ensure first call resolution, making the customer experience as seamless as possible. * Develop and maintain comprehensive product knowledge across all three lines of insurance (Auto, Homeowner, and Umbrella). * Cultivate strong relationships with our agents and partners, contributing to our collaborative work environment. * Utilize your analytical and decision-making skills to address policy changes and corrections effectively. * Exceed customer and agent expectations by delivering top-notch service through positive interactions and extensive product expertise. * The ability to work a flexible schedule is a critical aspect of this position. Hours for this position are shifts between: 8:00am-7:00pm Monday - Friday and 10:00am-3:00pm every third Saturday. QUALIFICATIONS * Strong interpersonal, communication, and organizational skills. * Analytical mindset with good decision-making abilities. * Proficiency in computer skills and data entry. * High motivation to take ownership and follow up on tasks. * Flexibility to adapt to a fast-paced, changing environment. * Ability to work weekdays and rotational Saturdays. * Must obtain a NJ Property & Casualty Insurance Producer License (You will receive fully paid training, and we will sponsor you for your insurance license). * High school diploma required, college degree is a plus! * Spanish language proficiency is a plus! * The ability to commute to Woodbridge, NJ for first 5 weeks for training. PERKS & BENEFITS * 4 weeks accrued paid time off, 8 paid national holidays per year, and 2 floating holidays * Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision) * Annual 401(k) Employer Contribution * Resources to promote Professional Development (LinkedIn Learning and licensure assistance) * Robust health and wellness program and fitness reimbursements * Various Paid Family leave options including Paid Parental Leave * Tuition Reimbursement ABOUT THE COMPANY The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of "A-/Excellent". #LI-DN #PRCSPA
    $35k-42k yearly est. Auto-Apply 13d ago
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  • IBHS Supervisor

    Wes Health System 4.1company rating

    Philadelphia, PA job

    JOB TITLE: IBHS Supervisor Reports to: Clinical Director IBHS/ Designee Applying for this role is straight forward Scroll down and click on Apply to be considered for this position. GENERAL OVERVIEW OF KEY ROLES & RESPONSIBILITIES: The IBHS Supervisor, meeting the requirements of a Behavioral Consultant will provide BC services and staff supervision for the IBHS Program. ESSENTIAL & CORE FUNCTIONS: 1. Provide BC services for a minimum caseload of 12 consumers. 2. Provide supervision to IBHS staff in accordance with the regulations. 3. Monitor the IBHS agency's compliance with regulations. 4. Complete FBAs for caseload and other consumers when needed. 5. Provide staff training. 6. Complete and monitor Performance Evaluations and Professional Development Plans for staff. 7. Ensure timely entry and proper delivery of IBHS. 8. Review completion of service documentation assuring regulatory and funding standards are met and adhered to. 9. Maintain an understanding of agency policies and procedures. 10. Field concerns of parents, schools, regulatory agencies regarding service delivery. 11. Oversee disciplinary actions in collaboration with Directors and HR. 12. Lead and documents staff meetings to review program and educate staff on agency policy, procedures and changes. 13. Attending collaborative meetings representing WES. 14. Assist in the development of IBHS procedures and ensure staffs' compliance. 15. Ensure outcome data is collected, reported, complied accurately and in a timely manner. 16. Complete Individual Treatment Plans and Progress Summaries. 17. Participate in Intensive Case Conference meetings. 18. Participate in Crisis Consults. 19. Assure continuous quality assurance/program development. 20. Comply with WES standards for service delivery. 21. Meet service productivity expectations. 22. Complete all paperwork within specified time frames. 23. Participate in and adhere to Individualized Training Plan. 24. Attend and participate in supervision in accordance with regulatory standards. 25. Adhere to WES's Code of Ethics and comply with State Mental Health Code. 26. Participate in continuous quality assurance/program development. 27. Maintain consumer confidentiality. ADDITIONAL RESPONSIBILITIES: 1. Performs other duties and special projects as assigned. PREREQUISITES & QUALIFICATIONS FOR THE POSITION: IBHS Supervisor shall meet one of the following: a. Be licensed in this Commonwealth as a Behavior Specialist. b. Have a certification as a BCBA or other graduate-level certification in behavior analysis that is accredited by the National Commission for Certifying Agencies or the American National Standards Institute. c. Have a graduate degree in ABA from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency. d. Have a minimum of 1 year of full-time experience in providing mental health direct services to children, youth or young adults and a graduate degree in psychology, social work, education, or counseling from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency. OR e. Completed a clinical or mental health direct service practicum and have a graduate degree in psychology, social work, education, counseling or a related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency. JOB TITLE: IBHS Supervisor 1. Knowledge of and a minimum of ten years working with mental health problems, CASSP, community resources and managed care systems preferred. 2. A minimum of five years' experience providing services for children and adolescents. 3. Criminal child abuse and FBI clearance required. COMPETENCIES & PERSONAL CHARACTERISTICS: 1. Proficient in computer programs such as Microsoft Office, Excel, Word and PowerPoint. 2. Solid oral and written communication skills. 3. Good organizational skills including the ability to prioritize work and manage conflicting deadlines. 4. The ability to work well with others. 5. The ability to handle conflicts with diplomacy and tact. 6. The ability to listen and evaluate objectively. 7. The ability to travel from school to school. ORGANIZATIONAL ACCOUNTABILITY & RELATIONSHIPS: The individual is to be supervised by the Clinical Director or Designee. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. WORK ENVIRONMENT: The work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time to noise level in the work environment is usually moderate. GENERAL SIGN OFF: Toe employee is expected to adhere to all agency policies and to act as a role model in the adherence to agency policies. xevrcyc I have read and understand this explanation and job description. Print Name: Signature: Date: Human Resources/Management Signature: Date: _
    $26k-40k yearly est. 2d ago
  • IT Help Desk Asset Technician

    Capital Rx 4.1company rating

    New York, NY job

    About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Location: NYC Office (4 days/week required) Position Summary: The IT Help Desk Asset Technicianassistsin managing our ticketing system, MDM software, and all IT equipment tracking/deployment. Position Responsibilities: Manage all IT Asset inventory, tracking all in office/deployed equipment using IT Asset management programs Maintain all IT assets through device life cycle, processing replacements/returns of all broken/outdated hardware across the company Collaborate with HR team to retrieve equipment from Collaboratewith internal partner teams toidentifycompliance, best practice, or other IT related policy needs within the cross functional existing processes and workflows;identifyand present enhancements and deploy solutions to the business. Responsible for all onboarding and offboarding related IT activities, including system-wide access,purchasingandretrieving ofequipment,upgrades,asset tagging,etc. Promptly respond to user requests via ticketing system/phone calls/IM Assistusers with access/system issues Write and update documentation for user reference Help build andestablishprocedures for newly established team Participate in a Help Desk OnCall schedule (tentatively will be 1 week/month, with potential higher volume at onset as the team grows). Required Qualifications: 2+Yearsexperiencein a Help Desk role (preferably in a medium or larger company) Acustomer-orientedapproach to problem resolution Experience maintaining IT Assets within asset management software Process, intake, and manage hardware repairs Ability to lift 30 lbs. regularly and up to 50 lbs. occasionally (for NYT "future onsite" roles only) Salary Range$24-$28 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at*********************************************
    $24-28 hourly 2d ago
  • Account Executive, PBA Services

    Capital Rx 4.1company rating

    New York, NY job

    About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Position Overview: The Account Executive/Strategic Account Executive - PBA Services is responsible for managing the planning, execution, growth & retention and client satisfaction of assigned clients in the Pharmacy Benefit Administration (PBA) market segment including Health Plans, Third Party Administrators (TPAs), and other Platform services. Additionally, this position will lead and collaborate through the broader Account Management team and with internal Capital Rx teams/departments as the client voice and advocate to ensure ongoing client satisfaction and to achieve client priorities and contractual obligations. This position acts as the quarterback and leader of the broader Account Management team who are aligned in support of our clients. This position reports to the Senior Account Executive/Senior Director, PBA Client Services. Position Responsibilities: Work closely with some of our biggest Texas-based clients and manage the complexities of working within a highly-regulated market of the TDI (Texas Department of Insurance) Provide oversight and direction to the broader Account Management team with a focus on member and client satisfaction, trend management, client growth & retention, and regulatory compliance to meet client specific objectives, client priorities and service model deliverables Lead and develop the client relationship strategy and the strategic business planning process across the clients in your portfolio while incorporating other internal staff where and when needed to build and foster relationships with influencers and decision makers. Maintain thorough knowledge and tracking of contractual obligations on assigned book of business, including financials, performance guarantees, terms, and reporting/compliance Manage and facilitate the Account renewal and contracting process with a focus on client retention and the client financial/PNL management Serve as the relationship lead on assigned book of business, incorporating other internal staff where and when needed to the relationship; build and foster relationships with influencers and decision makers at the client Anticipates customer needs and proactively identifies new opportunities within assigned accounts. Develop and maintain comprehensive knowledge of our business, including products and services to field questions from the client side and to answer timely & accurately Collaborate with internal teams to customize offerings and solutions, aligning with Health Plan/TPA Account needs and market demands - assemble internal resources to overcomes challenges. Analyze and interpret current pharmacy and healthcare trends, competitor activities, and industry regulations to inform strategic decisions, provide proactive recommendations for plan management and enhance the company's positioning within the PBA Services segment Lead, coach and support the Account Team on the effective positioning of the Capital Rx value proposition, our suite of Capital Rx Products and Solutions and JUDI capabilities available to our PBA clients Partner with our Business Development, Underwriting Teams & Senior Account Executives to support our PBA Account level growth and retention efforts by providing with Capital Rx sales support and market differentiator positioning, including RFP support, Broker/Consultant engagement and Best & Final support for prospective, existing and new and client business development needs Provide ongoing direction, coordination and coaching to the broader Account Team to align the Account Team understanding of the assigned client(s) business lines, strategies, key stakeholders & decision makers and priorities Serve as the content expert for Health Plan/TPA clients & opportunities Identify and help contribute to process improvement efforts Be accountable & own the client end-to end, inclusive of service model deliverables, contractual negotiations, client escalations and PNL management. All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. Required Qualifications: Bachelor's or advanced degree in health administration, business, or relevant professional experience. Bachelor of Pharmacy (B.S. Pharmacy) or Doctor of Pharmacy (PharmD) degree from an accredited institution is a plus Relevant professional experience for at least five (5) years in pharmacy - working within a health plan, managed care, or pharmacy benefits management (PBM) focused on Health Plans and Payer Commercial (Insured, Self-Funded, Exchange) and Government Program (Medicare & Medicaid) business lines. Health plan industry experience highly preferred Market and operational knowledge of Medicare Part D, Medicaid and Health Exchange pharmacy is required along with experience in supporting highly regulated business lines Track record of building trust in internal and external relationships Solution-focused problem solving and client positioning skills Exceptional written and verbal communication skills Ability to work with and influence peers in a team effort; leading cross-functional initiatives, meeting deadlines, and executing on deliverables while building strong internal relationships A decisive individual with sound technical skills, analytical ability, good judgement, and strong operational focus and detail-oriented perspective Flexible, highly organized, and able to shift priorities easily and work independently to meet deadlines Ability to effectively work with peers in a team effort Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and large data sets and other industry software programs Ability to travel and present to small and large groups; travel is estimated to be up to 25% and be variable by season and business cycle Preferred Qualifications: Experience working with clients who are subject to TDI (Texas Department of Insurance) rules and regulations #LI-BC1 Salary Range$120,000-$160,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at*********************************************
    $120k-160k yearly 6d ago
  • Office Manager and Executive Assistant to Managing Partner

    U.S. Realty Advisors, LLC 4.5company rating

    New York, NY job

    Executive Assistant to Managing Partner U.S. Realty Advisors is seeking a polished, proactive, and highly personable Executive Assistant & Office Manager to support our Managing Partner and keep our NYC office running seamlessly. This role is perfect for someone who thrives in a fast‑paced, high‑standards environment and enjoys being the go‑to person who makes the whole operation work. What you'll do Serve as a trusted extension of the Managing Partner-calendar management, travel coordination, expenses, and confidential support Manage day‑to‑day office operations: payables, vendors, supplies, building coordination Organize team events, assist with onboarding, and help cultivate a warm, professional office atmosphere Ensure the office remains polished, efficient, and welcoming Who you are 5+ years supporting senior executives (finance/real estate a plus) Exceptionally strong interpersonal skills with a polished, confident demeanor A “no job is too small” mindset paired with strong organizational instincts Positive attitude-genuinely enjoys being part of a collaborative, high‑performing team Discreet, proactive, detail‑obsessed, and calm under pressure Bachelors degree Why U.S. Realty Advisors Join a high‑performing team where professionalism, trust, and collaboration drive results. You'll directly support firm leadership and play a central role in the culture and daily operations of our NYC office.
    $47k-72k yearly est. 5d ago
  • Senior Digital Product Manager, Web & Mobile Experiences

    American Family Insurance 4.5company rating

    Boston, MA job

    A leading insurance company is looking for a Senior Digital Product Manager to lead the development of digital solutions for web and mobile platforms. This role focuses on transforming the customer and agent experience through strategic vision and collaboration with cross-functional teams. The ideal candidate will possess strong product management expertise, a data-driven mindset, and effective leadership skills. This position offers a competitive salary range and comprehensive benefits packages, including medical, dental, and a 401(k) plan. #J-18808-Ljbffr
    $112k-142k yearly est. 1d ago
  • Clinical Account Consultant, PBA

    Capital Rx 4.1company rating

    New York, NY job

    About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Position Summary: Capital Rx is seeking a strategic, client-focused Clinical Account Consultant to support all aspects of clinical functions to service client clinical needs. In this role, you'll ensure client satisfaction, retention, and trend management, while providing clinical support to clients across all lines of business. You'll collaborate directly with clients to develop and implement formulary and clinical strategies, support contract renewals, and contribute to clinical process improvements. If you're passionate about delivering exceptional service with a focus on clinical excellence and driving healthcare innovation, we'd love to hear from you! Position Responsibilities: Support clinical aspects of implementation for new clients, plans, plan changes, and other clinical plan set-up requirements. This may include gathering client clinical intent and plan requirements, building/coding plans and formularies, conducting peer-review quality control, and reviewing testing and claims output. Actively address all clients' clinical needs including the management and implementation of custom formularies, clinical criteria, and clinical strategies. Comprehend and effectively explain formulary, benefit, and clinical programs to clients, including intervention components, member and plan experience, book of business experience, and regulatory requirements as it directly pertains to clinical functions. Meet with clients to discuss clinical trends, review relevant pharmacy data, and provide recommendations with supportive rationale for formulary, clinical and plan management strategies. Analyze and interpret pharmacy claims data to identify clinical and plan trends and to offer insights for individual clients and across multiple clients. Communicate drug information to clients and respond to plan-specific clinical inquiries; support resolution of member-specific inquiries. Collaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentations. Actively attend and contribute to sales meetings and client presentations with a focus on clinical operations and clinical account management. Lead key internal clinical operations initiatives and general business needs/operations, as required. Identify and contribute to clinical process improvement efforts. Certain times of year may require meeting participation, testing, claims review, or other requirements outside of standard business hours, including weekends. Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. Required Qualifications: Doctor of Pharmacy (PharmD) degree from an accredited institution Current, unrestricted registered pharmacist license(s) Relevant experience of 3-5 years in a health plan or pharmacy benefits management (PBM) Direct account management experience supporting clients across multiple lines of business Proficient in Microsoft Office Suite with emphasis on Microsoft Excel Experience working with large datasets and analyzing raw data in Excel Ability to balance multiple complex projects simultaneously Exceptional written and verbal communication skills Flexible, highly organized, and able to shift priorities easily Attention to detail & commitment to delivering high quality work product Ability to travel and present to small and large groups Preferred Qualifications: Completion of managed care residency, preferred Prior account management experience of at least three (3) years, preferred Prior experience with Medicare line of business, preferred This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Salary Range$145,000-$165,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at*********************************************
    $145k-165k yearly 6d ago
  • 3-11 NURSING SUPERVISOR

    Windsor Health & Rehabilitation Center LLC 4.0company rating

    Windsor, CT job

    Job DescriptionDescription: We are looking for a dynamic and self directed Registered Nurse to join our team. Make your application after reading the following skill and qualification requirements for this position. Must have long term care experience and or be willing to learn in a fast paced environment. Ability to multitask while leading a nursing team is strongly desired. Delegate tasks to Charge Nurses and Nursing Assistants Able to work as a Charge Nurse as needed Conduct performance evaluation of the nursing xevrcyc team Requirements: RN License CPR Certification COVID 19 vaccination encouraged, but not mandatory to be considered for employment
    $79k-106k yearly est. 2d ago
  • Data Quality Engineer

    Capital Rx 4.1company rating

    New York, NY job

    About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Location: Remote (For Non-Local) or Hybrid (Local to NYC area) Position Summary: We are seeking a highly motivated and detail-oriented Data Quality Engineer to join our team. In this critical role, you will be the guardian of our data's integrity, ensuring the accuracy, reliability, and robustness of the systems that power our operations and analytics. You will be instrumental in building trust in our data and empowering the organization to make confident, data-driven decisions that drive positive healthcare outcomes. Position Responsibilities: Technical Issue Identification & Root Cause Analysis: Identify, investigate, and triage technical issues within the data engineering tech stack (specifically focusing on [Specify Key Technologies - e.g., Python, SQL, Airflow, dbt]). Conduct thorough root cause analysis, utilizing logs, database queries, and system monitoring data to pinpoint the source of problems. Log Analysis & Monitoring: Monitor and analyze system logs (e.g., using CloudWatch to validate application functionality, identify performance bottlenecks, and proactively detect anomalies. Develop and maintain dashboards to visualize key system metrics. Database Querying & Analysis: Utilize SQL to query and analyze data within the Snowflake data warehouse. Develop and execute complex queries to investigate data discrepancies, identify trends, and support troubleshooting efforts. Familiarity with SQLAlchemy is a plus. AWS Service Support: Collaborate with the engineering team on the support and monitoring of AWS services utilized within data engineering (g., EC2, S3). Assist with troubleshooting issues related to these services. Collaboration & Requirements Translation: Collaborate with Product Managers and engineers to understand business requirements and translate them into actionable test requirements and test plans. Participate in sprint planning and daily stand-ups. QA Execution: Conduct thorough QA tasks, including ticket review, refinement, testing (manual and potentially exploratory), and bug identification. Scrum Team Support: Partner with the scrum team to manage backlogs, refine tickets, and support roadmap development. UAT Support: Assist with UAT testing, stakeholder communication, and documentation to align team efforts with business goals. Compliance & Reporting: Ensure adherence to company policies, including timely reporting of noncompliance. Code of Conduct: Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. Minimum Qualifications: Bachelor's degree strongly preferred in Computer Science, Information Technology, or a related field. 3+ years of experience in a QA Analyst, Data Engineer, Business Analyst, or related role. Proficiency in Python Strong SQL experience; familiarity with Snowflake preferred. Familiarity with Agile methodologies and workflows. Experience with GitHub or similar source control repositories. Excellent communication and collaboration skills, with the ability to translate between technical and non-technical audiences both verbally and in writing. Strong analytical and problem-solving skills with attention to detail and QA principles A meticulous, detail-oriented mindset with a passion for ensuring data accuracy. Preferred Qualifications: Experience in the healthcare or PBM sector. Hands-on experience with modern data stack tools like Airflow, dbt, and Snowflake. Experience with CI/CD pipelines. Understanding of data warehousing concepts. Familiarity with automated testing frameworks and data validation tools. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Salary Range$85,000-$100,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at*********************************************
    $85k-100k yearly 6d ago
  • Business Analyst II

    Tokio Marine North America Services 4.5company rating

    Pennsylvania job

    We are looking for an individual who is passionate about developing solutions to help improve business processes, products, and systems. This person will join our high-functioning team that delivers and supports services across the U.S. and Mexico to the North American businesses of the Tokio Marine Group. This role will be responsible for business analysis functions in support of Philadelphia Insurance Companies (PHLY), TMNAS IT teams, and the TMNAS BA Practice. The ideal candidate for this position should apply their knowledge of the property and casualty (P&C) industry through developing, participating and monitoring technology solutions that enhance business processes. This individual must show a commitment to ongoing professional development as a Business Analyst within the insurance industry. This role requires close collaboration with business stakeholders, IT leadership, and vendor partners to gather and define business and functional requirements. Additional responsibilities include supporting testing and training initiatives, as well as contributing to operational support processes. A candidate for this position must be motivated to work within a varied range of high performing business and technical teams. Essential Job Functions: Ability to understand and express business needs from multiple perspectives by considering impacts to the organization from the beginning to the end of the effected process(es). Conduct research to address request by utilizing company created assets, industry publications and internet based references. Lead, support, and participate in business requirements gathering for projects and enhancements, utilizing business analysis tools and techniques such as process modeling, data analysis, and requirements management software. Facilitate effective communication between IT teams, business units, and external vendors through written and verbal methods. Identify and recommend changes to technology that improve efficiency, accuracy, and compliance of business processes. Perform operational support activities, including triaging production issues, advocating for business users, and managing defect resolution through deployment. Identify, evaluate, and recommend potential solution options. Support the resolution via projects and enhancements through production deployment. Participate in the full software development life cycle (SDLC), including both waterfall and agile methodologies. Conduct operational support turnover activities including creation of Quick Reference Guides, Standard Operating Procedures, Release Notes, and other job aids as applicable. Perform special duties and other projects as assigned. Comply with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at the Company. Build and maintain strong working relationships with IT team members, stakeholders, business units, and senior management. Degree / Licenses and Professional Certification Bachelor's degree preferred. Insurance Certification(s) preferred. Preferred Qualifications: 3+ years' experience as a Business Analyst. 1+ years' experience supporting underwriting functions in the property and casualty (P&C) insurance sector, or relevant experience in selling, servicing, or underwriting commercial lines insurance policies. Experience with custom developed policy administration systems is preferred. Experience with software packages such as Policy Decisions or Advantage will be considered. Familiarity with technology platform that enable the independent agency channel is desired.Some examples are web-based portals such as Unqork for sales and servicing of insurance policies; and digital distribution channels such as IVANS Familiarity with service management and requirements tools (e.g., ServiceNow, Jira, Azure DevOps, Modern Requirements) Capable of working independently. Excellent problem solving and analytical skills Experience writing business requirements and functional specs. Ability to decompose complex business and data requirements into specifications for developers and other stakeholders. Excellent written and oral communication skills to effectively convey complex information. Strong customer service orientation (responsive, consultative, collaborative and accurate). Self-starter with proven ability to take initiative to accomplish goals, with minimal oversight and direction. Knowledge of SDLC for both waterfall and agile methodologies. EEO Statement: Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
    $78k-109k yearly est. 1d ago
  • Senior BCM Analyst

    Tokio Marine North America Services 4.5company rating

    Pennsylvania job

    Develops crisis management, emergency management and contingency plans for Tokio Marine North America Services, and its group companies. Leads and provides incident response support for any type of natural, man-made or technological disaster. Essential Job Functions: Develops and implements plans, processes, policies and procedures for emergency management, crisis management and contingency planning program elements. Leads incident management for any type of natural, man-made or technological disaster. Provides incident support during emergencies, which may occur outside of standard business hours and require extended shifts depending on the severity and duration of the event. Participates in post-incident reviews and contributes to continuous improvement efforts. Communicates effectively with senior executives and leaders during crisis and emergency situations. Gathers and analyzes information; supports resolutions to address business issues for a specific business group. Tests multi-dimensional plans with various operational departments throughout group companies. Evaluates vendors, makes recommendations, and implements vendor requirements. Develops strategy, training materials, protocol and quick reference guides for emergency management, crisis management and contingency planning areas. Develops and leads tabletop exercises and training for group companies. Develops plans and procedures for the BCM Crisis Management Center. Manages efficient and effective usage of tools and integration with other tools as necessary. Initiates awareness processes to make necessary improvements for emergency management, crisis management and contingency plans. Qualifications: Bachelor's degree is preferred (preferably in Emergency Management or Business). A Business Continuity certification preferred. 7+ years of relevant experience. Ability to provide on-call support and incident response as needed during emergencies, including after-hours and weekends. As much advance notice and flexibility as possible will be provided. Ability to weigh business needs and articulate these needs to management. Knowledge, insight, and understanding of business concepts and processes that are needed for making sound decisions in the context of the company's business; ability to apply this knowledge appropriately to diverse situations. Experience with mass notification systems, such as Onsolve Send Word Now, and incident monitoring systems, such as Everbridge NC4, preferred. Working knowledge of Microsoft Office,and strong knowledge in Microsoft Excel preferred. Performs special projects and other duties as may be assigned. Strong customer service orientation, responsive, consultative, collaborative and accurate. Strong leadership ability: able to work with a group to set objectives and agenda, generate allegiance to those objectives, and motivate achievement. Familiarity with project management skills; planning, organizing, monitoring and controlling projects, ensuring efficient utilization of resources to achieve project objectives and deadlines. Strong interpersonal relationship building skills; able to work with a variety of people and groups in a constructive and collaborative manner. Strong analytical ability with the capability to determine the root cause of problems and issues.
    $84k-111k yearly est. 1d ago
  • Consultant III HPR Loss Control

    Tokio Marine America 4.5company rating

    Pittsburgh, PA job

    About Tokio Marine: Tokio Marine has been conducting business in the U.S. market for over a century and we are licensed in all states, Puerto Rico and the District of Columbia, and write all major lines of Commercial Property and Casualty Insurance. We provide unique insurance and risk management tools from our experienced staff of account executives, underwriters and loss prevention engineers and fair and timely claim settlement from a skilled team of claim professionals. We work with major brokers and leading independent insurance agents throughout the United States to serve the world's largest and most distinguished organizations. We are committed to creating value for our customers by providing ANSHIN (safety, security and peace of mind). We strive to be creative and passionate as we work towards our long-term success. Tokio Marine Holdings is Japan's oldest, and one of the largest property and casualty insurers. Founded in 1879, TMNF operates worldwide in 47 countries. With annual revenues of approximately $50 billion and an A.M. Best rating of A++, one of the highest in the industry, we are one of the top 20 insurance providers worldwide. Job Summary Provide professional Highly Protected Risk (HPR) loss control services to Tokio Marine America clients and Tokio Marine Management, Inc. Coordinates and conducts loss control management evaluations, physical surveys, loss analysis and training to assist Tokio Marine clients to improve and maintain loss control activities. Coordinates and conducts loss control management evaluations, physical surveys and loss analysis to assist Tokio Marine Management Underwriting in their evaluation of risk. Provide loss control technical support to Tokio Marine departments such as underwriting, claims and coordination. Coordinate loss control activities on select accounts ensuring service plans are maintained and completed, responding to customer requests and needs and supporting underwriting and claims at renewal and during the policy period. Essential Job Functions Performs loss control surveys of prospects and clients on request for information underwriting and evaluation from a loss control viewpoint for desirability. Coordinates loss control service to select clients requiring defined service standards. Prepares reports for clients, Underwriting and Branch concerning the loss control in effect, including loss analysis, conditions noted, recommendations for improvement and future needs. Assists in the development and presentation of programs and training seminars for clients and other departments in the Company. Responds to special requests from Underwriting Department and clients with prior approval from Loss Control Department Management. Develops and maintains Loss Control instructions for multi-location clients being coordinated by Loss Control. Completes all work scheduled in regular service assignments or requests in a timely manner. Maintains membership and actively participates in professional organizations approved by Departmental standards guidelines. Utilizes PC programs (Taurus, Presentation Software, etc.) in preparing presentations for prospects and clients. Plans and performs work scheduling in a timely and cost-effective manner. Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at the Company. Qualifications Bachelor's degree in engineering / science or equivalent job experience preferred. Five years' experience servicing major accounts preferred. Possesses a specialty in HPR loss control or comparable property insurance background. Good communication skills, both written and oral and capable of making presentations to a group. Good computer skills to include the use of Microsoft software, and other software. Valid driver's license free of any major violations. Physically capable of performing the job requirements - walking, carrying and climbing. Capable of significant amounts of travel. Salary range $150,000 to $170,000. Ultimate salary offered will be based on factors such as applicant experience and geographic location. Our company offers a competitive benefits package and bonus eligibility on top of base. TMA believes the perfect candidate is more than just a resume. If you don't meet every single requirement, but are still interested in the job, we encourage you to apply. Benefits: We offer a comprehensive benefit package, which includes a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. EEO Statement Tokio Marine Management is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, or sexual orientation.
    $150k-170k yearly 2d ago
  • Senior Actuary - Middle Market Growth & Analytics

    The Liberty Mutual Foundation 4.5company rating

    Boston, MA job

    A national insurance company in Boston is seeking an experienced Actuarial Analyst to support Middle Market growth through detailed actuarial analysis. This role involves collaboration with underwriting teams and requires strong analytical and communication skills. Ideal candidates will have a Bachelor's in a STEM field and relevant actuarial qualifications. The company offers a competitive salary and comprehensive benefits, emphasizing an inclusive workplace culture. #J-18808-Ljbffr
    $80k-120k yearly est. 1d ago
  • Startup Insurance Advisor - Fast-Paced Growth

    Vouch, Inc. 4.4company rating

    New York, NY job

    A tech-enabled insurance advisory is seeking a knowledgeable Insurance Advisor to enhance client satisfaction during the sales and onboarding phase. The role requires 2+ years in a client-facing capacity, as well as a property and casualty license. Ideal candidates should be adaptable and possess excellent communication skills. The position is based in New York with a hybrid work model requiring in-office attendance three days a week. Competitive salary package, including equity options, is offered. #J-18808-Ljbffr
    $73k-96k yearly est. 2d ago
  • Machine Learning Engineer

    Trov 4.1company rating

    New York, NY job

    At Pave, we're building the industry's leading compensation platform, combining the world's largest real-time compensation dataset with deep expertise in AI and machine learning. Our platform is perfecting the art and science of pay to give 8,500+ companies unparalleled confidence in every compensation decision. Top tier companies like OpenAI, McDonald's, Instacart, Atlassian, Synopsys, Stripe, Databricks, and Waymo use Pave, transforming every pay decision into a competitive advantage. $190+ billion in total compensation spend is managed in our workflows, and 58% of Forbes AI 50 use Pave to benchmark compensation. The future of pay is real-time & predictive, and we're making it happen right now. We've raised $160M in funding from leading investors like Andreessen Horowitz, Index Ventures, Y Combinator, Bessemer Venture Partners, and Craft Ventures. Research & Design Org Pave's R&D pillar includes our data science, engineering, information technology, product design, product management, and security teams. This organization builds, maintains, and secures a platform used by more than 8,500+ client organizations. Our engineering team moves between ideation, scoping, and execution in a matter of days while closely iterating with cross‑functional partners on requirements. At Pave, we use TypeScript, Node.js, and React, hosted on GCP. Compensation strategy is broken down into three pillars - compensation bands, planning workflows, and total rewards communication. We build products that make these processes seamless for customers. Over the next year, our roadmap is focused on enhancing the entire compensation lifecycle: from philosophy definition to market trend analysis, band adjustments, merit cycles, and employee communication. We're seeking passionate engineers who are excited about building robust, data‑rich systems that simplify complex compensation processes at scale. The Data Team @ Pave As part of the Data team at Pave, you will help us redefine how companies understand the labor market and determine compensation. Even the most innovative tech companies in the world often use spreadsheets full of flawed statistics to determine how to pay. At Pave, we've built a system of real‑time integrations that allow us to bring best practices from machine learning, data science, software tooling, and AI to an industry that is built on data, but doesn't have the tools it needs to fully leverage it. What You'll Do Architect and implement scalable ML systems for modeling compensation within a single company and across the market as a whole Collaborate with product and engineering teams to identify additional opportunities to leverage ML‑driven solutions Help evolve the technical direction of ML initiatives across the company Drive millions of dollars of revenue growth What You'll Bring 5+ years of experience building and deploying ML models in production environments Strong foundation in machine learning, statistics, and deep learning fundamentals Expertise in Python and modern ML frameworks (PyTorch, TensorFlow, or similar) Experience with large‑scale data processing and ML model optimization Experience with MLOps practices and tools (model versioning, monitoring, and deployment) Strong software engineering practices and experience with production systems Expert‑level SQL skills with experience writing complex queries and optimizing query performance Ability to navigate (and bring structure to) ambiguity; ability to bring a project from 0 to 1, or scale a project from 1 to 100 Compensation Salary is just one component of Pave's total compensation package for employees. Your total rewards package at Pave will include equity, top‑notch medical, dental, and vision coverage, a flexible PTO policy, and many other region‑specific benefits. Your level is based on our assessment of your interview performance and experience, which you can always ask the hiring manager about to understand in more detail. This salary range may include multiple levels. The targeted cash compensation for this position is (level depends on experience and performance in the interview process): P3: $195,000 - $215,000 P4: $230,000 - $250,000 Life @ Pave Since being founded in 2019, Pave has established a robust global footprint. Headquartered in San Francisco's Financial District, we operate strategic regional hubs across New York City's Flatiron District, Salt Lake City, and the United Kingdom. We cultivate a vibrant, collaborative workplace culture through our hybrid model, bringing teams together in‑person on Mondays, Tuesdays, Thursdays, and Fridays to foster innovation and strengthen professional relationships. Benefits Complete Health Coverage: Comprehensive Medical, Dental and Vision coverage for you and your family, with plenty of options to suit your needs Time off & Flexibility: Flexible PTO and the ability to work from anywhere in the world for a month Meals & Snacks: Lunch & dinner stipends as well as fully stocked kitchens to fuel you Professional Development: Quarterly education stipend to continuously grow Family Support: Robust parental leave to bond with your new family Commuter Assistance: A commuter stipend to help you collaborate in person Vision & Mission Our vision is to unlock a labor market built on trust. Our mission is to build confidence in every compensation decision. Equal Employment Opportunity As set forth in Pave's Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law. If you believe you belong to any of the categories of protected veterans listed below, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. #J-18808-Ljbffr
    $230k-250k yearly 3d ago
  • Billing Specialist

    The Phoenix Group 4.8company rating

    New York, NY job

    Join a dynamic financial operations team supporting legal professionals and their clients. This role centers on managing client financial interactions, with a focus on invoicing, digital billing platforms, and payment tracking. Key Responsibilities Prepare and submit client invoices, including digital formats, ensuring precision and timeliness Oversee billing workflows, monitor deadlines, and provide status updates on outstanding accounts Review and interpret custom billing agreements with a critical eye for detail Serve as a point of contact for internal stakeholders, resolving process-related issues and supporting system enhancements Collaborate directly with designated legal professionals to manage account lifecycles-from initial setup through payment coordination and account reconciliation Candidate Profile At least 2 years of experience in billing within a legal or consulting environment Familiarity with enterprise financial platforms (e.g., Elite 3E, Aderant, eBillingHub) Exposure to international billing practices and currency variations is advantageous Strong analytical skills for interpreting financial data and billing trends Exceptional accuracy and ability to follow complex instructions Professional communication skills across all organizational levels The Phoenix Group Advisors is an equal opportunity employer. We are committed to creating a diverse and inclusive workplace and prohibit discrimination and harassment of any kind based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. We strive to attract talented individuals from all backgrounds and provide equal employment opportunities to all employees and applicants for employment.
    $41k-56k yearly est. 4d ago
  • Psychiatric RN-$5,000 SIGN ON BONUS/4 DAY WORK WEEK

    Bridgeway Rehabilitation Services Inc. 4.2company rating

    Little Falls, NJ job

    Job DescriptionExpect Success at Bridgeway! We make a difference in people's lives by supporting their life goals - our employees and the people we serve alike. We invest in our employees through competitive compensation and benefits, best practice training, and fostering a team-oriented culture that promotes career development. We nurture an environment that values diversity, where inclusivity, equity, and belonging thrive. At Bridgeway, Everyone Learns and Grows together. We give you our best, so you can unleash your full potential. Make a Difference at Bridgeway Behavioral Health Services! Bridgeway offers uniquely rewarding experience in a supportive Team atmosphere. We invest in our employees. We offer excellent salary and benefits packages, and opportunities to advance your career. Become part of the Bridgeway Behavioral Health Services Team! Make a Future at Bridgeway! Who we are: Bridgeway values and promotes quality clinical and administrative practices to foster the best outcomes for persons who come to us for behavioral healthcare. We offer a work environment that supports teamwork, creativity, innovation, professional growth and dedication to the work. Bridgeway operates 13 PACT teams, along with more than 20 additional short-term, and longer-term integrated care and recovery service teams across 10 New Jersey counties. At Bridgeway, we never stop growing and innovating our vision of behavioral healthcare for the future. Why you should apply: As a Psychiatric RN, you willjoin an evidence-based program and a dynamic team for the opportunity to learn and refine your clinical and engagement skills and accomplish your dream of helping people to make progress on their unique recovery journeys. The work is sometimes challenging and always rewarding by engaging with persons we serve and co-workers as we all learn, grow, and thrive. Salary: $80,000- $90,000 annually Location: Elmwood Park, Passaic County, NJ Work hours: Full time 40 hours $5000 sign on bonus and 4 day work week available (Passaic County Location only) Apply promptly! A high volume of applicants is expected for the role as detailed below, do not wait to send your CV. POSITION OVERVIEW: Psychiatric RNs on PACT teams are critical to the success of the people served by Bridgeway. RNs provide nursing assessment, direct-support services, and primary health screening to individuals whose goals include recovery from mental illness and substance use conditions. PACT RNs use their skills to provide leadership, support, and education to other team members in nursing/medical treatment and health care. They are an essential part of a multi-disciplinary team working together to provide individuals the tools to become and remain stable and healthy. PACT RNs receive ongoing training, and supportive supervision as they deliver evidence-based interventions, and wrap-around services. REQUIRED QUALIFICATIONS: ⦁ Bachelor's degree in nursing preferred but associates in nursing accepted ⦁ Valid NJ Registered Nurse license ⦁ Valid driver's license, no more than one moving violation within the past 12 months EXCELLENT BENEFITS: Benefits: Medical, Dental, Vision, 403b, basic life and AD&D, flexible spending accounts, EAP Eligible for medical benefits after 30 days of employment Flexible work schedules, clinical training series, leadership development program 10 paid holidays (an 11th after 2 years of employment), generous vacation and sick time Bridgeway Behavioral Health Services was founded on a strong desire to fight disparity and injustice alongside people living with behavioral health conditions. xevrcyc We are dedicated to providing a multicultural workplace where everyone feels a sense of purpose and belonging. We provide equal opportunity for employees and applicants in all aspects of the employment relationship, without regard to race, color, national origin, sex, sexual orientation, gender, marital status, military or veteran status, disability, age, religion, or any other classification protected by law. #HP
    $80k-90k yearly 2d ago
  • 2026 Summer Global Investments Intern- Investment Compliance

    Aflac, Inc. 4.4company rating

    New York, NY job

    Opportunity: Intern - Global Investments Salary Range: $18.75 -$30.00 per hour Company: Aflac Asset Mgt. LLC Division: Global Investment Recruiter: Alisha Hargrove Job Posting End Date: 2/9/2026 Worker Designation This role is hybrid. This means yo Investment, Compliance, Summer, Intern, Global, Management, Business Services
    $18.8-30 hourly 2d ago
  • Clinical, Manager, Prior Authorization Technician

    Capital Rx 4.1company rating

    New York, NY job

    About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Location: Remote (For Non-Local) or Hybrid (Local to NYC area) Position Responsibilities: Oversee a dynamic team of pharmacy technicians engaged in the prior authorization process. Analyze available data to provide prior authorization staffing, workflow, and system enhancement recommendations to maximize team agility and performance. Actively participate in the prior authorization technician metric and quality goal setting process. Generate and deliver comprehensive reports on prior authorization technician metrics to both internal and external stakeholders. Assist the talent acquisition team in the hiring, evaluation, training, and onboarding of new employees. Investigate/resolve escalated issues or problems from team members, clients, and other internal teams. Key stakeholder in ensuring the prior authorization review platform is optimized for technician functions. Maintain relationships with external Independent Review Organizations and clinical resource vendors. Support the training and growth of both new and existing staff members in adherence to proper procedures. Collaborate with prior authorization leadership to develop process improvements and support long-term business needs, recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and help establish best practices for conflict resolution while actively participating in problem identification and coordinate resolutions between appropriate parties. Assists with in other responsibilities, projects, implementations, and initiatives as needed in accordance with the policies and procedures established within the department. Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines. Maintain compliance with local, state, and federal laws, in addition to established organizational standards. Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions. Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies Required Qualifications: Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required Bachelor's or Associate's degree is preferred 4+ years of PBM or Managed Care pharmacy experience required Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint Strong clinical background required Excellent communication, writing, and organizational skills Ability to multi-task and collaborate in a team with shifting priorities Preferred Qualifications: 2+ years of regulated market prior authorization operations experience or knowledge of how to operationalize regulated market requirements Previous prior authorization operations leadership experience Salary Range$80,000-$90,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at*********************************************
    $80k-90k yearly 4d ago
  • Claims Trainee, Property Damage

    Plymouth Rock 4.7company rating

    Plymouth Rock job in Mount Laurel, NJ

    This individual is responsible for the handling of Auto Property Claims in accordance with NJ Unfair Practices Act. The environment is fast paced with heavy phone work. The position requires patience and the ability to function professionally in adversarial situations. RESPONSIBILITIES * Investigate and interpret policy provisions, endorsements and conditions to make a coverage determination in the automobile property claim. * Identify and investigate Contested Coverage Claims with recommendation prepared for coverage committee. * Responsible for the investigation of the auto accident to make a liability assessment. This includes interviewing first and third party claimants, witnesses, investigating officers and other relevant parties, along with securing pertinent records, documentation and loss scene information. * Analyze the investigation to determine proximate cause, negligence, and damages. * Evaluate and adjust reserves as necessary. * Prepare dispatch instructions for field personnel to inspect vehicles. * Negotiate and settle claims within his/her individual authority. * Submit claims for approval to supervisor when over his/her authority or for guidance, review and/or referral when appropriate. * Maintain an effective follow-up system on pending files. * Prioritize and handle multiple tasks simultaneously. * Adjust to fluctuating workload. * Advise insureds, claimants, brokers on the status of the claim. * Act as an intermediary between the Company, preferred vendors and customers. * Resolve all disputes that may arise. * Ensure that service, loss and expense control are maintained at all times. * Adhere to privacy guidelines, law and regulations pertaining to claims handling. * Investigate and initiate subrogation when applicable. * Handle and respond to arbitration and special civil part lawsuits pertaining to property damage. * Participate in catastrophic claim handling as requested/needed. This may include traveling to other locations and extended hours. * Other duties as assigned. QUALIFICATIONS * Strong customer service, organizational, verbal, and written skills are required. * Basic personal computer skills including working knowledge of Microsoft Office Suite products. * Bachelor's Degree from a four-year college or university required and/or 2-4 years of relevant work experience. * Recent college graduates are encouraged to apply! SALARY The pay range for this position is $45,000 to $52,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. PERKS & BENEFITS * 4 weeks accrued paid time off + 8 paid national holidays per year, and 2 floating holidays * Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision) * Annual 401(k) Employer Contribution * Resources to promote Professional Development (LinkedIn Learning and licensure assistance) * Robust health and wellness program and fitness reimbursements * Various Paid Family leave options including Paid Parental Leave * Tuition Reimbursement ABOUT THE COMPANY The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of "A-/Excellent". #LI-DNI #CLMTEC
    $45k-52.5k yearly Auto-Apply 13d ago

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