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Performs quality control audits to evaluate accuracy and effectiveness of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements. Description 35% Conducts focused quality audits
Posted 1 day ago
Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation including evalu
Posted 1 day ago
Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plan
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description Customer Service Advocate II Nicole Thompson 60% Ensures effective customer relations by responding accurately, timely, and courteously to telephone,
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description 60% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk in inquiries. Handles s
Posted 1 day ago
Coordinates the overall proposal management process and provides guidance into the proposal related policies, processes, and procedures. Facilitates all phases of the proposal life cycle to ensure complete, compliant, responsive, and customer centric proposals are delivered on time for various solicitations (RFPs, RFIs, RFQs, task orders, etc.) ranging from minimum size and complexity to very larg
Posted 1 day ago
Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Description 80% May provide any of the following in support of medic
Posted 1 day ago
Responsible for supporting the development and maintenance of a digital media strategy. Responsible for leading digital marketing efforts, coordination of marketing campaigns, content management, monitoring traffic and responding to feedback. Various digital properties include websites, apps, email, SMS and digital experience content. Description 30% Coordinates with business partners on the cre
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquires may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description 60% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk in inquiries. Handles si
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all telephone inquiries. Performs research as needed to resolve inquiries. Description 65% Ensures effective customer relations by responding accurately, timely and courteously to telephone inquiries. Accurately documents inquiries. 15% Initiates minor /clerical adjustments based on provider request or processes adjustments or perfor
Posted 1 day ago
Through effective, professional Customer Relationship Management, consults with customers to understand their needs and how CPSS' services may identify and address their business problems/opportunities. Provides research, analysis and leadership on individual and team work assignments, making decisions independently with guidance from manager. Using in depth analysis, recommends creative and effec
Posted 1 day ago
Through effective, professional Customer Relationship Management, consults with customers to understand their needs and how CPSS' services may identify and address their business problems/opportunities. Provides comprehensive research and analysis as well as leadership on individual and team work assignments, making decisions independently with some guidance from manager. Recommends creative and e
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all complex inquiries from Medicare Advantage members and providers. Inquiries are typically non routine and require deviation from standard screens, scripts, government websites and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty Medicare claims and/or non medical appeals. Det
Posted 1 day ago
As member of the senior management team, provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies. Description This position can be worked remotely. Must be willing to tra
Posted 1 day ago
BlueCross BlueShield of South Carolina
- Charleston, SC / Atlanta, GA / Burlington, VT / 47 more...
Involved in all aspects of the Molecular Diagnostic Program (MoIDX) laboratory operations and serves as an internal subject matter expert, applying medical knowledge to advise decisionmakers in support of MoIDX's mission. Responsible for review and approval of documentation and reports, supporting clinical testing strategies, as well as new assay development and validation. Serves as an ambassador
Posted 1 day ago
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