Oversee performance of end to end provider servicing Resolve complex problems and provide guidance to members of own team Drive the design and implementation of programs that build / nurture positive relationships between the health plan, providers, and practice managers Ensure implementation of training and education programs for external providers Identify gaps in netwo

Identify potential health care business customers Develop business relationships with agents and/or brokers to increase sales Promote sales of health care and ancillary products to Mid Market Employers through brokers. This includes educating and keeping brokers up to date on products and pricing, evaluating, and discussing with brokers, developing recommendations on whic

Address any escalated issues sent to them, the SAE, or other field employee Work with the central team and their manager to coordinate resolution Meet with customers quarterly (or more often if requested) to review service related statistics including ideas for improving or enhancing the customer's total service Conduct training/education with customers on UHC eServices,

Mainly handling inbound calling, NO knocking on doors Answer incoming phone calls from prospective members and identify the type of assistance and information the customer needs with the goal to convert the caller to a qualified lead and ultimately sale Ask appropriate questions and listen actively to identify specific questions or issues while documenting required inform

Organize and manage incoming claims Work through a queue with other team members to identify claim needs Identify billing discrepancies Determine member insurance coverage and eligibility status Ensure compliance with federal and state laws and regulations Sort and organize appeals to identify eligibility needs Communicate with legal teams on appeal status Make offers to

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Com

The MarTech and Digital Strategies leader is responsible for the following Oversee E&I's implementation of the new Adobe suite of products (AJO, CDP, Assets) Represent E&I's priorities to Evolution program technical leadership. Strategic planning and roadmap of the E&I MarTech stack; a collection of 15+ platforms representing a $4MM+ annual marketing operations investment

Evaluate and assess each request verifying eligibility and specific product Determine benefit level based on site of service Utilize written criteria to approve, pend or send the case to the medical director for review Send cases for pending process when appropriate Maintain at least 98% accuracy of clinical review case notes in Facets Maintain productivity standards and

Manage and execute the proposal production for assigned RFPs in accordance with the established project process Analyze RFP documents to identify and document specific proposal production requirements and participate in meetings to ensure appropriate production strategies are in place and fully compliant with all production requirements for a given opportunity Create prop

Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff Work most often impacts a large business unit, or multiple markets/sites You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succe

Address any escalated issues sent to them, the SAE, or other field employee Work with the central team and their manager to coordinate resolution Meet with customers quarterly (or more often if requested) to review service related statistics including ideas for improving or enhancing the customer's total service Conduct training/education with customers on UHC eServices,

Interpret and analyze claims, capitation and membership data, and recommend best approaches in support of underwriting, actuarial and utilization analyses Lead projects to completion by contributing to database creation, statistical modeling and financial reporting Quickly understand and run with vague ad hoc analytical requests from internal organizational leaders and de

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

The UHC Director Compensation will lead all total rewards related strategies and activities in support of the Segment goals including Provide a full spectrum of consulting and analytical compensation services by translating business and segment strategic direction into meaningful compensation programs Consults on all total rewards programs and partners with the enterprise

Manage administrative intake of members Work with hospitals, clinics, facilities, and the clinical team to manage requests for services from members and/or providers Reviewing incoming and outgoing referrals, and prior authorizations, including intake, notification, and census roles Handle resolution/inquiries from members and/or providers Handle incoming crisis calls fro