JOB TITLE Insurance Authorization Specialist (must be bilingual English/Spanish!) GENERAL SUMMARY OF DUTIES Responsible for obtaining managed care authorizations and verifying patient insurance benefits. Analyzing utilization data from health plans' claims as required. Maintains optimal patient, referring physician and insurance company satisfaction. SUPERVISION RECEIVED

This position supports the Risk Management Department in directing the worldwide Risk Management Property and Casualty insurance programs for asset protection and strategic advantage. Essential Duties and Responsibilities Manage process and performance to obtain optimal outcomes involving a claims portfolio of approximately 10 million of annual cash outflows, and other as

Responsible to maintain primary ownership of annuity, life and senior health cases which requires engaging in frequent communication and coordination between agents, insurance carriers, and internal resources. Responsible for setting their agent's expectations appropriately and providing a World Class Customer Service experience, based on our customer's expectations, thro

Responsible to maintain primary ownership of annuity, life and senior health cases which requires engaging in frequent communication and coordination between agents, insurance carriers, and internal resources. Responsible for setting their agent's expectations appropriately and providing a World Class Customer Service experience, based on our customer's expectations, thro

The Senior Lending Compliance Analyst is a highly experienced individual contributor role and will report to the Director, Compliance. The Senior Lending Compliance Analyst is responsible for operational support of the Compliance Department; assists the Director, Compliance in developing, implementing, testing, and administering all aspects of TDECU's Compliance Managemen

Educate providers to ensure they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans Ensure providers have in depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives, and patient care best practices Conduct detailed a

Manage, evaluate and optimize third party vendor relationships. Direct and support global retirement plans strategy and global financial wellness programs. Coordinate and oversee day to day retirement plan operations. Collaborate with other benefits staff to develop and enhance plan specific communications. Identify/develop best practices ensuring plan compliance and oper

Job Description Work directly with the Department Manager to achieve department productivity and goals Accurate and efficient processing of Currency Transaction Reports Accurate review of Anti Money Laundering alerts with appropriate written decisioning Thorough and accurate research of possible suspicious activity scenarios with appropriate written decisioning Thorough an

The essential duties and responsibilities (including but not limited to) Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence. Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.

The essential duties and responsibilities (including but not limited to) Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence. Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.

This position is responsible for the SDO process improvements in any of the following areas eligibility, enrollment & billing, claims administration and member/provider services across one or more lines of business. Partnering with operational process owners to establish strategic goals and process measures. Modifying, monitoring, continually improving, and standardizing

Be responsible for oversight of the insurance authorization process regarding case management of care clusters and patient pathways. To include timely and complete processing of eligibility and benefit verification, initial and ongoing authorization requests following set guidelines and accurate entry of related information in designated software system. Review and build

2220 Haine DrSte 40,Harlingen,Texas,78550 8584,United States of America This role is 90% remote and 10% travel. Travel to our DaVita clinics to provide education and guidance to DaVita patients about health insurance and the implications of different insurance options is required . Candidate must reside in Harlingen, McAllen, Brownsville, or the surrounding area. This role

Educate Providers to ensure they have the tools they need to meet Quality, Risk adjustment, growth (as appropriate) and Total Medical Cost goals per business development plans Ensures Providers have in depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives and patient care best practices Conduct detailed an

West Creek 3 (12073), United States of America, Richmond, Virginia Anti Money Laundering (AML) Supervisor Enhanced Due Diligence Team The Anti Money Laundering (AML) Investigator II supervises various AML processes, which might include suspicious activity investigations, currency transaction reporting, global sanctions screening, enhanced due diligence or other AML process