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The Escalation Response Specialist II responds to member and provider complaints and escalations, providing resolutions in a timely manner. They document and track issues, perform root cause analysis, and coordinate with various departments to enhance service quality and reduce escalations.
The Escalation Response Specialist III responds to complaints and escalations from members or providers. Responsibilities include resolving escalated issues, documenting complaints, identifying trends, collaborating with the Claims department, and ensuring timely internal communication. The role requires maintaining knowledge of products to enhance customer support and improving member/provider experiences.
Design, develop, and implement complex enterprise software solutions using GoLang, collaborating with various technical and non-technical roles. Responsibilities include analyzing user needs, creating designs, implementing solutions, and participating in application support activities, while adhering to best practices and standards.
As a Contract Negotiator II, you will recruit and develop a network of healthcare providers by negotiating participation agreements in line with corporate and state guidelines. This involves ensuring documentation accuracy, overseeing contract compliance, and coordinating with internal and external departments for efficient contract management.
The Lead IT Data Scientist will design and develop scalable AI and machine learning solutions, conduct research, and utilize big data tools to enhance health outcomes. Responsibilities include leading model development, data analysis for business decisions, ensuring data quality, and deploying models with CI/CD practices. The role requires collaboration with internal customers to meet AI/ML needs and communicating findings to non-technical partners.
The Lead UX Designer will enhance user experience for applications by creating user flows, wireframes, mock-ups, and prototypes, while collaborating with UX teams and stakeholders. They will conduct user research, advocate for usability, mentor designers, and ensure consistent design standards across products, particularly in a healthcare context.
The Senior Manager of Incident Response oversees the Cybersecurity Incident Response Team, manages security incident investigations, recommends security enhancements, leads a technical team during incidents, and communicates with senior leadership to ensure efficient incident response.
As a Bilingual Retention Representative, you will assist members with government health program applications, respond to inquiries, maintain member relationships, and ensure proper documentation. Your goal is to enhance membership retention by providing education and support throughout the recertification process.
The Provider Data Management Specialist I is responsible for maintaining accurate databases and reports to ensure compliance with state requirements. This includes managing provider records, scheduling verifications, and providing reports. Knowledge in claims, credentialing, and provider data management is highly preferred.
The Manager, Provider Relations & Contracting will lead recruitment, contracting, and retention efforts for behavioral health providers, manage contract compliance, negotiate agreements, and oversee business processes associated with provider contracting. This role includes fostering relationships with providers and monitoring operational and financial performance to guide negotiations.
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