• US National

An Actuarial Analyst maintains risk adjustment model, identifies risks, estimates risk scores and financial impact, and leads actuarial studies. Requires Bachelor's degree in Mathematics, Statistics, or Economics and 2 actuarial exams.

• US National

Provides general administrative support including document preparation, file management, scheduling meetings, arranging travel, ordering office supplies. Administers various programs, projects, and assignments. Coordinates work effort, monitors metri..

• US National

Build organizational capability by facilitating programmatic educational workshops and developing leadership tools and resources. Spearhead change champion programs as needed.

• TX

Perform monthly audits of clinical functions in Utilization Management, Case Management, Member Assessment Team, Health Management, and Disease Management. Ensure regulatory compliance and report findings to leadership. Maintain detailed auditing records.

• ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, KY, MS, AL, MI, IN, TN, GA, FL, OH, NC, SC, WV, VA, PA, DC, CT, NJ, NY, RI, NH, ME, MD, DE, VT, MA

Analyze financial reports, evaluate business opportunities, generate forecasts, and create financial models. Develop policies and procedures to support all finance activities. Bachelor's degree and 3-4 years of experience required. Preferred MBA and ..

• US National

Evaluate existing workflows, procedures, and systems to identify inefficiencies and opportunities for optimization, proposing and implementing innovative solutions. Lead and support cross-functional projects from initiation to completion...

• TX, WA, FL, NM, AZ, or US National (Not hiring in TX, WA, FL, NM, AZ)

Responsible for providing medical oversight and expertise, developing and implementing utilization management programs, participating in quality improvement activities, and ensuring compliance with regulatory requirements.

• IA

Provide telephone, clerical, and data entry support for the Case Management team. Review data to identify principal member needs and assist in implementing care plan. Coordinate required services in accordance with member benefit plan.

• US National

Proactively identifies problem areas and researches background and potential solutions. Develops clinical team improvement plans in collaboration with a VP of Clinical Ops or a Medical Director. Assists MHI Clinical Training team...

• US National

Lead planning and implementation of innovative business solutions for government-sponsored health insurance markets. Design scalable business models, manage process improvement, and provide strategic direction to a team of business architects.

• US National

Responsible for managing internal business projects and programs, including planning and directing schedules and budgets. Monitors project progress and may engage external vendors. Focuses on process improvement and organizational change management.

• US National

Updates credentialing software systems with required information. Requests credentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals.

• US National

Handles and records inbound pharmacy calls, assists with prior authorization requests, explains policy/guidelines, communicates plan benefit information, assists with coverage determinations and appeals, maintains call tracking system, meets quality ..

• US National

Manages the vision of employee development. Integrates organizational business needs into learned offerings and priorities. Conducts training needs analyses to understand specific group needs.

• US National

Conduct data collection and abstraction of medical records for HEDIS projects. Train and assist in collecting medical records, comparing documentation to determine if preventive and diagnostic services have been correctly performed.

• US National

Responsible for investigating healthcare fraud, waste, and abuse. Conducts thorough investigations, produces audit reports, collaborates with departments and regulatory agencies, ensures compliance, and maintains coding accuracy.

• US National

Supports Claims and Enrollment operations through vendor management, data analysis, and reporting. Reviews vendor performance, prepares forecasts, and assists in process improvement. Requires a Bachelor's degree and 1-3 years of healthcare or vendor ..

• US National

Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims.

• US National

Responsible for taking and making telephone calls with prospective members with the intent to educate them on benefits of Molina products and then conducts enrollment into product of choice over the phone or other sales enrollment channel desired.

• US National

Architect and design system solutions solving business problems. Provide leadership and direction to engineers and align solutions with enterprise strategic direction. Responsible for system stability, scalability, and performance.

• US National

Responsible for preparation, processing, and maintenance of new members and re-enrollment. Verify enrollment status, make changes to records, and address enrollment questions or concerns. Maintain records in the enrollment database.

• CA

Administrative support for document prep, file management, meeting scheduling, travel arrangements, and supply ordering. Assists in program/project admin, coordination, and improvement. Helps plan, organize, retrieve data, and present info on operati..

• US National

Conduct outbound calls to schedule appointments with Nurse Practitioners. Provide high-quality customer service, remove barriers for members, and maintain confidentiality. Participate in special projects and perform other assigned duties.

• US National

Administer claims payments, maintain claim records, manage a caseload of claims, and reduce defects via proactive error identification. Evaluate claims using standard principles and state-specific policies. Meet department quality and production stan..

• US National

Designs and implements processes and solutions associated with data mining, analysis, and modeling. Extracts and compiles information from large data sets, provides data analysis, and collaborates with internal and external clients.

• NY

Performs processes to resolve the following eligibility exceptions within the required State/Regulatory timeframes: enrollment file errors, ID card generation errors, PCP assignments and 834 enrollment files to vendor/third party administrators.

• US National

Analyzes user information requirements, defines communication strategy, writes and revises technical information about company products, gathers and organizes technical information, and coordinates layout for publication.