BASIC FUNCTION: This position is responsible for the delivery of information and analysis on client cost and utilization data for all large and complex accounts; serving as the primary contact for reporting needs for HCSC accounts; coordinating with other areas of HCSC to make benefit recommendations; making regular presentations to accounts; and consulting with HCSC accounts on their information

rethink IMPACT What if health care could be different? And what if you could help make it different every day? At Regence, we're striving to transform health care from the inside out. It's a mission we passionately uphold, and one that guides every decision we make. And we seek the visionary, driven individuals bold enough to chart the future with us. Storage Systems Administrator Portl

BASIC FUNCTION: This position is responsible for providing the high-level consultative and strategic oversight for assigned Health Care Management account(s) to meet the needs of the customer. In collaboration with the Strategic Account Executive with in the Sales and Marketing organization, cultivates relationships, liaise with vendors and service accounts to support custom clinical/medical manag

BASIC FUNCTION: This position is responsible for managing, planning and implementing block of existing accounts to meet specified targets and service accounts to expand the business and meet corporate and divisional sales/renewal objectives. This position works closely with the assigned Major/National Strategic Account Executive as the primary project manager to develop tactical plans and execute

reaffirm PRIDE It feels good to make a difference. To be a part of a company that improves people's lives every day. That's pride from the inside out. We're Regence, and we're striving to transform health care with everything we do. As the region's largest not-for-profit health insurance plan, Regence has more than 6,500 employees in Washington, Oregon, Idaho, and Utah. We're innovators.

STRATEGIC PLANNING AND COTNRACTING: Evaluate the geographic, financial and network access impacts of individual provider agreements. Compare network access of CareFirst to commercial competitors. Determine alternate access for similar provider types and compare quality of care measures. Quantify appropriate financial terms commensurate with negotiation leverage. Prepare negotiation strategie

In this highly visible role, you will oversee the day-to-day pharmacy operations while establishing the overall pharmacy vision and direction, and leading 3 segments of the Pharmacy Division -Pharmacy Network Audit, Pharmacy Benefit Management, Operations & Compliance and Pharmacy Business Development. Responsibilities will include: • directing all business activities • providing str

Job duties include but are not limited to the following: - Provide project leadership to the CHS new business launch project - Gathers, supports and develops the resources needed to execute business plans and implement the strategic direction of the related work - Translates project needs, budget and requirements into actionable plans; maintains status of plans and develops corrective action p

Job duties include but not limited to the following: - Apply medical knowledge and expertise in reviewing claims and subscriber/ provider inquiries - Render medical decisions on claims, identifying questionable medical practices, existence of medical necessity, level of reimbursement and extent of benefit coverage - Document findings and render medical decision in various BCBSF systems - Mana

BASIC FUNCTIONS: Under supervision, this position is responsible for processing claims requiring investigation, phone calls, accessing resource materials and several support files; screening and editing claims data for accuracy; and processing for adjudication. JOB REQUIREMENTS: 1) High School Diploma or GED. 2) Data entry and/or typing experience. 3) Clear and concise verbal, written and interp

BASIC FUNCTION: This position is responsible for delivering employee services requiring knowledge of HR policies and procedures in such areas as salary and benefit administration, employee relations, wellness, or employee development; researching and providing solutions to the more difficult employee and retiree issues and concerns; working with all areas of HR to ensure effective employee service

BASIC FUNCTION: This position is responsible for managing, planning and implementing block of existing accounts to meet specified targets and service accounts to expand the business and meet corporate and divisional sales/renewal objectives. This position works closely with the assigned Major/National Strategic Account Executive as the primary project manager to develop tactical plans and execute

The responsibility of the position is to supervise operational activities a Reconsideration Department. The position is responsible to meet CMS workload requirements and to implement and maintain an effective QIC Appeals program as defined by CMS, which involves primarily meeting CMS standards for the timely and accurate review of the QIC appeals. Job Duties & Responsibilities: • Supervi

Job duties include but not limited to the following: - Provide telephonic case management of Workers' Compensation claims by facilitating and coordinating all aspects of the injured worker's medical care in a timely manner and with consideration to the criteria based model - Maintain high standard of file documentation to ensure attention to detail and file accuracy - Interact with strategic p

Job duties include but are not limited to the following: - Responsible for reviewing business processes and activities and providing detailed analyses - Identifies trends and problems, evaluates practices, conceptualizes new process and activities, and builds a business case for implementation - Recommends, implements and manages both the change and related communication process - Manages subcom

Processes a variety of customer transactions that involve suspended claims, adjustments, and other customer inquiries due to missing information, other party liability, nonstandard pricing, and other special circumstances. Qualifications: High school diploma or GED. * Minimum of one year prior work experience in claims, data entry, bank transaction processing or accounting required.* D

BASIC FUNCTION:This position is responsible for researching and responding to telephone and written inquiries in a prompt, accurate and objective manner. JOB REQUIREMENTS:* High School Diploma OR GED.* 6 months customer service experience OR 6 months experience in an office environment.* Data entry and/or typing experience. * Interpersonal, verbal and written communication skills.* Analytical and

BASIC FUNCTION:This position is responsible for researching and responding to telephone and written inquiries in a prompt, accurate and objective manner. Qualifications: JOB REQUIREMENTS:* High School Diploma OR GED.* 6 months customer service experience OR 6 months experience in an office environment.* Data entry and/or typing experience. * Interpersonal, verbal and written communic

Help Montanans live healthier lives with a rewarding career as an Actuarial Analyst. Blue Cross and Blue Shield of Montana has an exciting opportunity for a conscientious person who enjoys the challenge to solve complex problems and enjoys working in a fast-paced environment. This position is responsible for working within the actuarial department in pricing and setting claim reserves for BCBSMT

Leads the implementation of the provider engagement model within the Health Management & Integration (HMI) division through the development of a detailed project plan for successful implementation of the strategic plan for the HMI division. Work to coordinate actions and timelines of the HMI division with the actions and timelines of the overall Provider Engagement and Provider Engagement Integrat

BASIC FUNCTION: The position will be responsible for leading the strategy and sales operations for the Consumer Markets business (<65, Medicare Supplemental and Part D) for the whole enterprise which includes sales, member growth and profit/loss responsibility. The position will control the strategic planning, marketing, direct sales, and front end operations (including tele-sales, new busin

BASIC FUNCTION:Under supervision, this position is responsible for processing claims requiring investigation, phone calls, accessing resource materials and several support files; screening and editing claims data for accuracy; and processing for adjudication. Qualifications: JOB REQUIREMENTS:* High School Diploma or GED.* Data entry and/or typing experience.* Clear and concise verba

Responsibilities include: • understanding project scope and objectives • optimizing, managing and providing direction to the project team • ensuring proper application of EPMO standards/methodologies • coordinating the roles of the project team • delivering full project objectives on time and within budget • developing high-level business cases, post implement

reaffirm PRIDE It feels good to make a difference. To be a part of a company that improves people's lives every day. That's pride from the inside out. We're Regence, and we're striving to transform health care with everything we do. As the region's largest not-for-profit health insurance plan, Regence has more than 6,500 employees in Washington, Oregon, Idaho, and Utah. We're innovators.

This position is accountable for prompt, accurate, thorough and courteous responses to all customer inquiries. The work hours for this position are Monday-Friday 11:30 AM- 8:00 PM. Qualifications: -Bilingual Spanish/English skills -One year of claims processing or customer service work experience -Strong verbal and written communication skills -Strong organizational, analytic

redefine STRENGTH We're using our resources to transform health care - from the inside out. And we're educating our members and empowering our employees to help them. Promoting health and wellness in all that we do. And you're a part of it. Your vision, drive, and determination make all things possible. And we make it happen - together. Sales Manager - Associate & Affinity Programs Sea

redefine STRENGTH We're using our resources to transform health care - from the inside out. And we're educating our members and empowering our employees to help them. Promoting health and wellness in all that we do. And you're a part of it. Your vision, drive, and determination make all things possible. And we make it happen - together. Sr. Product Manager - Consumer Direct Health Produc

Regence began more than 90 years ago, when a community of loggers came up with an innovative idea to pool their healthcare dollars. That forward-thinking spirit is alive and well, moving us into a whole new world of health care. We have the creativity and energy of a start up. The stability and vision to see it through. Collaborate with smart people developing smart tools to keep our members he

BASIC FUNCTION: This position is responsible for managing, planning and implementing block of existing accounts to meet specified targets and service accounts to expand the business and meet corporate and divisional sales/renewal objectives. This position works closely with the assigned Major/National Strategic Account Executive as the primary project manager to develop tactical plans and execute

The Volunteer State Health Plan, Inc. (VSHP) CHOICES program offers person-centered care planning, service coordination, and support services for members receiving long-term care services such as home and community-based services (HCBS). The HCBS care coordinator is responsible for promoting interdependent collaboration with the member, physician/primary care manager, family, and other members of

Job duties include but are not limited to the following: - Market and sell our leading edge Workers' Compensation solutions to target prospects using a consultative selling approach. - Manage the sales process including: prospecting and pre-qualifying accounts, assisting in Request for Proposal responses, scheduling on-site presentations, acting as a liaison with the prospect, jointly negotiati

Assist Market Intelligence Manager and Senior Analysts provide company employees and management with strategic and tactical information and analysis of company business, markets, competitors and customers. Assists with and occasionally is solely responsible for the design and management of research projects performed to aid decision-making and supports company goals. Assists with or may be solel

reaffirm PRIDE It feels good to make a difference. To be a part of a company that improves people's lives every day. That's pride from the inside out. We're Regence, and we're striving to transform health care with everything we do. As the region's largest not-for-profit health insurance plan, Regence has more than 6,500 employees in Washington, Oregon, Idaho, and Utah. We're innovators.

Job duties include but are not limited to the following: - Responsible for data analysis to identify trends, cost drivers and opportunities to develop effective intiatives for assigned accounts - Make recommendations to address group-specific findings and issues driving costs - Aggressively manage the driving costs of the assigned population - Coordinate and manage group-specific Clinical Account

Regence began more than 90 years ago, when a community of loggers came up with an innovative idea to pool their healthcare dollars. That forward-thinking spirit is alive and well, moving us into a whole new world of health care. We have the creativity and energy of a start up. The stability and vision to see it through. Collaborate with smart people developing smart tools to keep our members he

The Volunteer State Health Plan, Inc. (VSHP) CHOICES program offers person-centered care planning, service coordination, and support services for members receiving long-term care services such as home and community-based services (HCBS). The HCBS care coordinator is responsible for promoting interdependent collaboration with the member, physician/primary care manager, family, and other members of

redefine STRENGTH We're using our resources to transform health care - from the inside out. And we're educating our members and empowering our employees to help them. Promoting health and wellness in all that we do. And you're a part of it. Your vision, drive, and determination make all things possible. And we make it happen - together. IT Asset Analyst Seattle or Tacoma, WA or Portla

BASIC FUNCTION: Under the direction of the Manager, this is an entry-level position supporting Sales Representatives or Account Management personnel in the prospecting, acquiring or renewing business. JOB REQUIREMENTS: 1) 2 years health care management experience OR 2 years customer service experience involving gathering data from databases, data input, and assisting clients; 2) State Insurance

redefine STRENGTH We're using our resources to transform health care - from the inside out. And we're educating our members and empowering our employees to help them. Promoting health and wellness in all that we do. And you're a part of it. Your vision, drive, and determination make all things possible. And we make it happen - together. IT Asset Analyst Seattle or Tacoma, WA or Portla

We are seeking a Registered Nurse to join our Medical Services team as a Nurse Case Manager. Responsibilities include assessment, facilitation, planning, and advocacy in the case management process to coordinate health care benefits for members leading to the most successful outcomes in the most cost-effective manner. The Nurse Case Manager works collaboratively with members, families, and doctor

redefine STRENGTH We're using our resources to transform health care - from the inside out. And we're educating our members and empowering our employees to help them. Promoting health and wellness in all that we do. And you're a part of it. Your vision, drive, and determination make all things possible. And we make it happen - together. IT Asset Analyst Seattle or Tacoma, WA or Portla

Blue Cross Blue Shield of Massachusetts is an Equal Opportunity Employment/Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, or any other characteristics protected by law. Position Summary The National Accounts Senior Underwriter II is responsible for the pr

Job Description: JOB SUMMARY: Analyze business issues and identify projects and technologies with management, which will produce significant operational results and add value to the corporation in the areas of EDI and Information Exchange. Formulates and defines system requirements and objectives based on both user needs and a solid understanding of applicable business systems and industry requi

rethink IMPACT What if health care could be different? And what if you could help make it different every day? At Regence, we're striving to transform health care from the inside out. It's a mission we passionately uphold, and one that guides every decision we make. And we seek the visionary, driven individuals bold enough to chart the future with us. Java Web Developer Portland, OR

Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests -Utilizes clinical proficiency to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, ch

Job Description: JOB SUMMARY : Serve in a leadership role in all projects requiring database activities with focus on the EDR system design, logical and physical model development and process integration. Effectively manage a team that will support technical requirements definitions, functional specifications, design documentation, vendor selection, and vendor integration as manager of a key tec

Reporting to the VP and Chief Medical Officer, you will join our highly effective team of healthcare executives and provide senior level leadership that foster our goals for member wellness, quality improvement, cost efficiency, performance improvement and an industry-leading clinical model. You will oversee medical policy development and integration, compliance and appeals, and quality managemen

In this role, you will provide physician support and leadership for all aspects of medical management, including concurrent review, case management, prior authorization and appeals. The successful candidate will also provide expertise on reimbursement and treatment protocols, guide staff in the interpretation of medical policy, analyze data from a variety of sources to identify trends and/or issue

This position is responsible for the generation of timely and accurate billing and accounts receivable functions for clients on self insured and minimum premium funding arrangements. Accountable for the financial controls and general accounting functions including management of unique banking arrangements, claim funding mechanisms, and monthly/ annual financial reconciliations. Responsible for en

redefine STRENGTH We're using our resources to transform health care - from the inside out. And we're educating our members and empowering our employees to help them. Promoting health and wellness in all that we do. And you're a part of it. Your vision, drive, and determination make all things possible. And we make it happen - together. Software Quality Assurance Analyst Portland, OR