Provides professional development coaching and training to Members. Coordinates and completes case management of Administrative Referrals. Consults with Human Resources and supervisory personnel from client companies regarding employee issues and concerns and HR practice policy. Conducts telephonic triage and assessment on issues including behavioral health, substance abu

Conducts telehealth and in person intake assessments and triage, providing in the moment support to members on issues, including but not limited to behavioral health, substance abuse, relationship, and work life, and coordinates resources. Provide onsite support and training to client organizations. Coordinates and completes case management of intakes. Makes clinical dete

Claims/Customer Care Specialist I TPA Processes routine healthcare claims while providing customer service via inbound/outbound phone calls and written communications. Assists with projects as directed by management. Performs other duties as assigned. Claims/Customer Care Specialist II TPA Processes routine to moderately complex healthcare claims and/or adjustments while

Communicates with business unit(s) and sourcing to ensure collaboration with any potential performance issues with supplier along with any other. Helps identify high risk suppliers and develops performance tracking / key performance indicators based on services being performed; ensures key contractual components are being followed. Facilitates the need for maintaining a b

Ready for a change? We offer flexibility in making your own schedule and offer remote or hybrid work locations. We're building our teams across America and hiring in 30 states! Our team Reserve National Insurance Company (formerly known as Kemper Health) is now MedMutual Protect! We stand for integrity, fairness and financial stability. Our company has the approval and co

Ready for a change? We offer flexibility in making your own schedule and offer remote or hybrid work locations. We're building our teams across America and hiring in 30 states! Our team Reserve National Insurance Company is now MedMutual Protect! We stand for integrity, fairness and financial stability. Our company has the approval and confidence of policyholders througho

Ready for a change? We offer flexibility in making your own schedule and offer remote or hybrid work locations. We're building our teams across America and hiring in 30 states! Our team Reserve National Insurance Company (formerly known as Kemper Health) is now MedMutual Protect! We stand for integrity, fairness and financial stability. Our company has the approval and co

This is a hybrid role requires work to be performed at an onsite physical location on a regular basis (generally 2 3 days/week in Brooklyn, Ohio ). Collaborates with other software developers, business systems analysts, and liaisons to translate user requirements and systems objectives of increasing complexity into a logical, efficient and optimal systems design. Develops

Plan, organize, and manage staff and overall operations to ensure stability of the organization's infrastructure. Hire, develop, and retain highly responsive and customer focused analysts to ensure the effective operation of the ITOC. Manage tools, systems, and procedures to ensure effective management of issues and customer satisfaction. Guide the creation, maintenance,

In the engagement manager role, you will work closely with Executive Leadership in identifying, understanding, and meeting their specific needs and pain points. Success in this role will be demonstrated by improved client retention and satisfaction while growing new business opportunities with existing clients. The ideal candidate will be a proactive problem solver with e

Value Based Contracting Data Analyst Working under general supervision, supports the operational infrastructure for the Value Based Contracting (VBC) provider incentive program. Develops and maintains internal and external data flows to optimize analytics tool (EZ Info) capabilities for value based contracting programs. Assists with managing vendor relationship. Compiles

Working under direct to general supervision, monitors the Company's provider network with respect to quality and utilization performance standards. Develops standard reporting and analytics to support Value Based Contracting (VBC) initiatives. Assists in supporting the contracting regions with quality, utilization, and cost analysis. Provider Network Performance Analyst I

IT Project Manager II Manage all stages of the IT projects assigned with management support, including planning, implementing and monitoring activities. Work with IT line managers and team members to develop appropriate methodology plans and activities with appropriate tasks, resources, milestones, cost analysis and timelines. Provide all levels of project communications

Collaborates with leadership and end users (nurses, physicians, pharmacists, support staff) to conceptualize and solution opportunities to meet the business needs and improvements. Conducts interviews, learns the business functions, educates, offers options and support through individual and group sessions. Reviews configuration requirements with systems staff. Supports d

Gathers applicable statutes, regulations and documentation and compiles and reports compliance data for product filings to regulatory agencies. Supports workflow associated with statutory and regulatory changes. Follows new or enhanced processes based on research. Assists with responding to state product filing objections. Administers standard regulatory change management