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We are seeking candidates with experience in managing a caseload of first-party property claims across various home types, including traditional homes, mobile homes, and condominiums, within a standard authority limit. Responsibilities include making coverage decisions, assessing and valuing damages, and interacting with policyholders, public adjusters, attorneys, and other third parties throughout the claims management process. Candidates must adhere to state compliance requirements and company guidelines for claims handling.
The Representative II employee will work closely with several different teams within Provider Network Services including the RFI Team and Pharmacy Credentialing. The RFI Team's efforts will be primarily responsible for aiding incoming day-to-day activities. Our RFI Team handles time-sensitive requests required by law or in support of legal processes external to our company. Other areas, including the Pharmacy Credentialing Team, will be to aid other employees and team leads with workloads to meet internal/external goals and guarantees.
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Do you have a passion for data analysis and problem solving? Put your skills and interests into work by joining our Financial Change Order (FCO) group. An individual who joins our team will be responsible for completing financial assessments for clients seeking to make pharmacy benefit plan changes. The team’s primary goal is to ensure proper financial controls and improve client level financial performance.
5+ years’ communications or marketing writing experience required. Strong verbal and written communication skills and the ability to communicate effectively with members, all levels of management, clients, prospects, and executives. Ability to write at the member-facing level in plain language for all to easily grasp the content.
Small Description: Billing Specialist I will be responsible for qualifying, preparing and submitting claims to Medicare Part B, Major Medical and Medicaid. Individuals must work with LTC facility staff, Omnicare pharmacy operations staff, prescriber offices, third party payers, patients and/or their responsible parties and claim processors. This position requires work within several different operating systems and web-based programs to retrieve document images, collect supporting or additional information on files and work claims through to resolution to ensure compliant, timely and accurate billing practices.