• Woonsocket, RI, Hartford, CT, Scottsdale, AZ, Chicago, IL, Dallas, TX

Provide advice and guidance on company policies, manage grievances and workplace inquiries, assist with coaching, corrective actions, terminations, and serve as a labor relations expert for business unit leaders.

• NY

Grow customer relationships and sales attainment in key markets. Direct account management activities to achieve maximum revenue attainment and patient participation for contracted business arrangements. Travel required up to 33% of the time.

• NY

Develop and execute account plans to achieve maximum revenue, compliance, and customer satisfaction with assigned clients. Includes team leadership, mentoring, and training responsibilities. Requires 3 years of work experience and ability to handle i..

• Woonsocket, RI, Scottsdale, AZ, Buffalo Grove, IL

Responsible for techno-functional impact analysis, design, and code construction activities for software development. Manage and support engineers, prioritize tasks, and collaborate with stakeholders to deliver high-quality projects on time and withi..

• Frankfort, KY

Perform intake of calls from members or providers regarding services, screen requests for appropriate referral to medical services staff, approve services that do not require a medical review, and maintain accurate and complete documentation of requi..

• US National

Case Manager RN responsible for telephonic case management, applying clinical judgment to reduce risk factors, addressing complex health and social indicators, and engaging members to assess their health needs.

• Springfield, IL

Lead the design, development, and implementation of procurement solutions within the ServiceNow platform. Collaborate with procurement stakeholders to gather requirements and customize workflows and forms. Provide technical leadership and mentor juni..

• UT, AZ, ND, MN, CA, NE, NM, MO

Provide service to clinical teams in support of optimal care. Generate administrative and medical necessity denial letters, make calls to providers and utilization reviewers, and schedule and coordinate appointments between providers and medical...

• VA

Receive and follow up on referrals to engage with members who are victims of human trafficking. Provide case management support, advocacy services, and access to resources for survivors. Collaborate with departments and community partners to ensure i..

• OK

Demonstrated experience with clinical program components, formulary designs, and prescription benefit trends. Experience working in a high production team environment.

• San Antonio, TX

Analyze and approve routine claims, apply medical necessity guidelines, verify eligibility, identify discrepancies, and apply cost containment measures. Route complex claims to Senior Claim Benefits Specialist.

• US National

Design, develop, and maintain automated solutions for Mainframe Db2 software. Collaborate with software development teams for process improvement and automation. Troubleshoot and resolve database-related issues.

• RI, AZ, NY, TX, IL, MA, FL, CT, CA

Inform and execute strategies to address payer and industry requirements. Develop go-to-market tactics and measure results for retail pharmacy network, product, and service initiatives. Build effective relationships and align stakeholders across the ..

• OK, Oklahoma City, OK

Manage and oversee compliance with provider engagement responsibilities, manage local team to deploy national engagement model, co-facilitate provider advisory group and JOC meetings to implement changes via coordination Quality Management.

• US National (Not hiring in HI)

Facilitates member healthcare through assessment, care planning, provider coordination, and psychosocial services. Reduces risk factors, consults with supervisors, and monitors care quality through case management and quality processes.

• Cumberland, RI

Manage a team to ensure compliance with Business Continuity program policy, develop and lead planning activities, collaborate with business unit leaders to address deficiencies, coordinate exercises and client reviews, and manage emergency...

• TX

Design, develop, and maintain automated solutions for Mainframe Db2 software upgrades, deployments, backup and recovery, monitoring, and performance tuning. Collaborate with software development teams to integrate database automation process. Propose..

• FL

Review and coordinate in-bound referrals for infusion patients. Communicate with internal and external partners, review insurance benefits, and maintain accurate documentation. Demonstrate flexibility, meet deadlines, and have strong problem-solving ..

• US National

Develop relationships with specialty pharmaceutical manufacturers, present clinical services to external clients, collaborate with pipeline resources, manage and optimize new product launches, deliver clinical education and training.

• FL

Provide targeted, personalized service to members and medical office providers. Handle site of service transitions based on medical policy. Educate members and providers on Aetna products and maintain compliance with ERISA and client requirements.

• MN

Review and adjudicate complex claims, handle customer service inquiries, identify and report possible claim overpayments/underpayments, and train and mentor junior staff. 2+ years of claim processing experience required.

• CA

Develop and execute customer service strategy, identify customer-specific service issues, manage plan administration activities, and support client needs in multiple time zones. Requires 2+ years of health insurance and customer service experience an..

• CT

Develop and optimize ML models and pipelines, upgrade and maintain ML platform, mentor junior engineers, seek opportunities to lower cloud costs. Required: ML pipeline/platform development, cloud native analytics, ML-centric programming. Pr..

• CA

Support the Account Manager with retaining and growing a specific book of business. Communicate and present information to audiences at all levels. Respond to customers' requests and build internal relationships with teams that support the business.

• VA

A Clinical Transformation Specialist is responsible for developing and implementing physical and behavioral health integration programs, providing education and technical support, and interfacing with providers to develop and implement Value Based Co..

• Hartford, CT, Chicago, IL, Atlanta, GA, Blue Bell, PA, Overland Park, KS

Assess risk, analyze market data, develop new product offerings, collaborate with various teams, and oversee actuarial priorities to drive business growth and improve competitive position in the international market.

• US, or US National

Deliver analytics and insights to support operations. Act as internal analytics specialist, utilizing tools such as SSIS, SSRS, Teradata, Alteryx, and Tableau. Support data automation reporting and develop business logic metrics.

• TX

Analyze specialty benefit requests, review client documentation, generate FAF folder requests, serve as subject matter expert for eProject, collaborate with Specialty BRM and Manager, evaluate project status, ensure timely completion.

• Phoenix, AZ, or US National

Formulate pricing strategy and execute financial modeling. Collaborate with sales and account services to provide recommendations on pricing and negotiation strategy. Develop and maintain domain expertise in PBM and enterprise profitability.

• NV, TX

Develops strong internal and external relationships to manage a book of business. Executes objectives aligned with customer and organizational goals, offers creative solutions, and collaborates cross-functionally to ensure client needs are met.

• FL, GA, SC

Develop and implement account management strategies, execute renewals, assess competition, maintain annual business plans for existing customers. Collaborate with stakeholders to address customer needs and drive financial performance.

• NY, NJ

Maximize revenue, retain and grow client relationships, and expand assigned book of business by negotiating and promoting Meritain Health products and services. Provide strategic leadership to service teams.

• CA, AZ, FL

Manage relationships with facilities, physicians, and ancillary providers. Foster growth and enhance network for the First Health Network. Lead a team of Provider Relations Network Consultants across the US.

• Harrisburg, PA

Supervise and evaluate staff, meet financial and operational objectives, build a strong team through training and mentoring, manage productivity and resources, resolve complex grievances, work rotational shifts.

• FL

Grow DMO network via contract negotiation, provider credentialing, and Non-Par office recruitment. Analyze fees and negotiate with dental network providers. Requires Microsoft Office proficiency and Bachelor's degree or 5 years of dental/medical insu..

• KS

Negotiate, analyze, and manage contracts with providers across all lines of business. Recruit providers to expand the network. Collaborate cross-functionally on pricing and reimbursement activities. Develop and refine network strategies.

• IL

Lead and direct the IAM TechOps function for all businesses. Build and establish the operating model, collaborate with IAM Build team, manage security incidents, and drive the implementation of the IAM strategy.

• MA

"Lead provider relationship manager responsible for implementing solutions, optimizing interactions, resolving issues, supporting operations, conducting meetings, and guiding team members. Bachelor's degree required.

• RI

Lead the execution of SOX projects, manage project scope, draft audit issues and reports, and oversee project team. Perform and document audit activities, interact with internal audit and business line management, and meet administrative reporting re..

• CA

Manage provider relationships, implement solutions to achieve satisfaction, cost targets, and efficiency targets. Deliver presentations and trainings, resolve issues, and identify opportunities for improvement. Travel up to 20%.

• NJ, NY, OH, MI

Lead a team to prevent, investigate, and prosecute healthcare fraud and abuse. Provide direction and counsel on case handling. Develop relationships with law enforcement agencies and deliver training programs.

• Hartford, CT

Lead cloud engineering and automation teams to deliver innovative cloud-based solutions aligned with business goals. Develop cloud strategy, oversee cloud engineering management and automation, and foster team leadership and development.

• Harrisburg, PA

Lead Solution Architect responsible for developing business, application/integration, data, infrastructure, platform, and security architectures. Collaborate with various teams to create solution architectures for key strategic initiatives and delive..

• Hartford, CT

Lead a team of skilled engineers to design, develop, implement, and maintain integration solutions critical to the organization's infrastructure. Establish performance monitoring and optimization processes, ensure solutions comply with regulatory req..

• RI

Manager specializing in strategic data analyses to support key business decisions for the PBM line of business. Use data-driven insights to develop winning business strategies and enhance existing solutions. Strong expertise in financial modeling, da..

• Harrisburg, PA

Responsible for developing solution architectures for strategic initiatives. Collaborate with various teams to create architectures representing business, applications/integration, data, infrastructure, platform, and security.

• Bloomington, MN, Downers Grove, IL

Lead discussions and negotiations for high-value rebate contracts with pharmaceutical manufacturers. Develop and foster strong relationships with direct manufacturers and industry partners. Coordinate with key leaders responsible for pharmacy benefit..

• US National

Manage client experience for a large health plan's Medicaid, Exchange and Commercial markets. Ensure regulatory compliance, work with Sales and Account Services teams, mentor team members, and develop new procedures. Minimum 8 years of healthcare exp..

• NC

Develop and deploy enterprise automation using AI, ML, NLP, and cognitive services. Manage cloud-based and other AI and cognitive solution platforms. 4 years of IT development experience and knowledge of AI, NLP, ML, and cognitive services concepts r..

• Hartford, CT

Perform complex analytics and reporting on population health management, health and economic outcomes. Optimize risk scores, collaborate on risk adjustment programs, and provide process improvement recommendations.