of Job Responsible for implementing end to end campaign creation, execution, delivery and measurement, primarily leveraging Salesforce Marketing Cloud email/journeys, Adobe Campaign, Adobe Experience Manager (CMS), and Adobe Analytics. Participate in the creation of SFMC campaign journey/workflow design, to execute email campaign activation and delivery. Develop automated

Manage the day to day responsibilities of telephone performance, coaching/counseling the customer service team, and inventories of offline work including eCorrespondence, social media, and HIPAA/Privacy form updates. Responsible for systemic testing related to updates to the CRM and the website portal; assist in training initiatives. Drive weekly meetings with call center

Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance. Develop studies, analyses, and presentation materials needed to appropriately inform decision makers. Complete pricing analysis, experience analysis and studies, financial projections, and other actuarial/financial calculations. Run, modify, and create

of Position We are seeking a talented Grievance & Appeals Specialist who will be responsible for responding to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, State, and other regulations. They will process appeals and grievances to facilitate the accurate administration of benefits and clinical

of Job Utilize a collaborative process of education, assessment, planning and engagement to promote participants' adopting improved lifestyle behaviors that support achieving and maintaining optimal health status. Empower participants to develop the skills and confidence required to effectively self manage their health and wellbeing. Foster high quality relationships while

Develop cash forecasting models to ensure adequate liquidity. Work with business areas across the enterprise to understand the impact of business activity on the cash flow forecast. Perform financial modeling that links cash activities to the financial statements and general ledger. Provide leadership and help to develop team members. Responsibilities Perform and provide

Develop, implement, and administer the vision, strategy, and goals of the department. Provide leadership over the Accounts Payable Team ensure the timeliness and accuracy of all Accounts Payable reports and information; ensure compliance with and enhancing internal control procedures; monitor all workflows, processes and system related activities within the department. Pr

Act as a liaison and operate as a vital link between specific Facility, Ancillary, Delegated and/or Professional providers and EmblemHealth. Responsible for day to day operations for all activities related to contracts with minimal supervision and direction, contract optimization, implementation of new programs and to assist with provider issues, education materials, as w

of Position The Care Team Associate II serves as a member of the Care Team in the treatment and care of patients who assists providers with clinical services and administrative tasks to support population health guided best in class care. The position works under the supervision of the Practice Administrator and in collaboration with the Nurse Manager. The Care Team Associ

Proactively receive and respond clearly to telephone calls and correspondence from members regarding billing, benefits, coverage, payment, coding, and health services policies and procedures. Demonstrate a customer service attitude on the initial call with a commitment to resolve customer issues including claims, benefit and enrollment inquiries through health plan naviga

of Job Manage the day to day sales activities of the Direct to Consumer and Individual markets (Medicaid, Child Health Plus, The Essential Plan and QHP) and implement any strategic or tactical plans. Work closely with the Regional Sales Leader, Government Assisted Program (GAP), Enrollment and Customer Service to ensure high levels of service and responsiveness. Responsibi

Deliver operations training programs that encompass a blended approach (instructor led modules, self paced activities, flipped classroom, group activities, videos, and eLearning). Responsible for multiple training topics (Products, Guidelines, polices & procedures, Systems utilized by Ops staff, etc.) Responsibilities Facilitate delivery (in person and virtual) of product

of Position Serve as the key operational liaison with Provider Network Management and Finance responsible for the reconciliation, reprocessing/recoupment and provider communication for claim payment integrity challenges. Oversee contract review; ensure that contract provisions are in alignment with corporate goals. Develop and implement dashboards to monitor performance. D

Serves in an account management (non sales) role as the primary business to business liaison between ConnectiCare and its provider network and is responsible for all interactions between the organizations. Continuously educates provider community about ConnectiCare and its policies and procedures. Build and develop partnerships with ConnectiCare's Tier I and Tier II provi

of Position Provide professional nursing care to patients and proactively support efforts to ensure that standards for patient satisfaction, patient safety, and quality of care are maintained, as established by AdvantageCare Physicians. Primary liaison between patients, staff and physicians and support the Advanced Care Model. Organize and provide clinical supervision to t