Prepare, process and maintain new member or group enrollments Respond to member eligibility or group questions and verify enrollment status Reconcile eligibility discrepancies, analyze transactional data and submit retroactive eligibility changes Research errors by comparing enrollment error reports against system information along with records from the Center for Medicar

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

Assist in efforts to enhance ease of use of physician portal and future services enhancements Assist providers and members with basic inquiries about claims, authorizations, benefits, and other issues Fostering and maintaining proactive, positive relations throughout the provider network by communicating with provider offices through face to face visits, emails, telephone

Serve as single point of contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract reimbursement, Optum's internal processes and priorities, and other Optum initiatives, as applicable Monitors performance of assigned PCPs, identifies low performing PCPs and works with IPA leadership to dev

Accountable for a full range of provider relations including engagement with and development of prospective providers Design and implement strategies to increase the membership of providers in the network Create and execute a marketing plan to build and nurture provider network Identify needs in provider network, incorporating potential gaps related to composition, servic

Load, process, and summarize various data types and files using MATLAB or similar program. Further organize, clean, sort, and analyze data using SPSS, R, SAS, or related data analysis programs and interpret meaningful findings in tables, graphs, and written form. Conduct casualty assessment using currently available high rate blast data and published computational models.

Must have High school diploma, GED or equivalent required, Two year degree preferred. Minimum of 3 years previous experience working for a Health Plan, IPA, or other Managed Care Organization. Minimum of 2 years previous direct experience that included verifying and maintaining provider information and provider contract configuration in a managed care transaction system .

Senior Claim Examiner Workers Compensation (CA) Requisition ID 2024 25313 Job Locations US CA Brea Position Type Regular Full Time Category Claims Business Unit BUS_TPA US Excellence In Everything We Touch Position Summary GREAT WORK FROM HOME CAREER OPPORTUNITY! Seeking candidates with experience managing CA WC claims! SIP is a requirement! Bonus Opportunities! Multiple