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Provides financial reconciliations and reports/analysis of Medicare Trust Fund activities to support government requirements. Prepares/documents complex financial analysis projects following standard practices and procedures. Extracts financial data from various accounting and information systems. Performs financial analysis of data. Description 25% Reviews and/or prepares financial statements,
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Under general supervision, performs a variety of routine to moderately complex clerical/accounting functions such as inventory balancing, reconciliations, generating refund request letters, processing disbursements and deposits, keying journal entries and logging items in accordance with standard procedures in one or more of the following areas; general accounting, accounts payable, accounts recei
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Functions as team leader for the accounting/finance support staff in performing a variety of accounting support functions. Ensures procedures are followed and deadlines are met. Solves routine and complex problems. Maintains job procedures, distributes work, and provides feedback to management. Description 40% Provides training and guidance on accounting responsibilities for current or new suppo
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Responsible for submitting stop loss claim packets and responding to any requests for additional information. Additionally, the claims must be tracked and monitored. Complex analysis is performed and queries are generated to file and validate the claim submissions. Description Prepare and file 50% and 100% stop loss claim packets. Run queries, compile eligibility data and submit claim packet. A
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Oversees the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identifies and implements process improvement opportunities. Description Manages the medical review process. Maintains a well trained staff. Develops/implements medical review strategy with th
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Perform all phases of applications systems analysis and design. Analyze systems specifications and develop applications to support information systems processes. Prepare detailed specifications from which complex programs will be written. Design, code, test, debug, document and maintain these programs. Formulates scope and objectives through research to develop or modify complex systems. This posi
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Provides a wide variety of administrative and staff support services. Coordinates more complex and diverse area specific projects. Administers programs, projects and processes requiring area specific knowledge. Operates a desktop computer and is proficient in working with assorted software, tools and systems utilized in the area. Description 50% Provides coordination for a variety of area specif
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Defines customer needs in technical and business contexts. Ensure the proposed technical and business solutions meet the customer's objectives for the work effort. Provide guidance with planning and prioritization of business analysis activities in support of large project and support efforts. Description 25% Elicit and document user requirements to meet a business objective. Identify and valida
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Ensures enforcement of group financial agreements and resolution of delinquency problems. Performs all functions necessary to resolve major accounts receivable issues. Analyzes outstanding premiums to determine collectability. Provides accurate financial statement information. Description Provides timely/accurate financial data for collections process. Audits group claims expenses, administratio
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Defines customer needs in technical and business contexts. Ensure the proposed technical and business solutions meet the customer's objectives for the work effort. Description This position is on site in Nashville, TN. Cannot consider remote. 50% Elicit and document user requirements to meet a business objective. Identify and validate requirements and organize the information into a logical docu
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Ensures that member and group level benefit materials are produced with accuracy and timeliness. Description Produces health/dental benefit books using customer software. Document production includes research of group files, customization of benefit language, correction of group documents, editing revisions, proofing of documents, coordination with marketing, underwriting, quality control, bene
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This role is responsible for providing information in concise/well written reports to assist in the sales and marketing plans. Assists with marketing, sales and compliance projects. Collaborates with the Medicare Advantage team to ensure critical success factors are met including, but not limited to, creating and maintaining various spreadsheets, managing timelines, and reviewing marketing and com
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Responsible for the management and daily operations of the technical staff responsible for devising logical, automated statistical analysis programs and procedures. Description 30% Manages the activities of research and analysis staff responsible for complex statistical analysis programming and sophisticated data interpretation to support customer requirements. 20% Maintains effective communicat
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Leads corporate distribution systems, general agents, brokers, and other market support personnel. Responsible for planning, product development, marketing services, production and profitability for as few as two states to regions with as many as ten states. Customarily and regularly engaged in outside sales. Description 25% Leads, markets, recruits, and motivates general agents, brokers, and ot
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Researches the substance of complex appeal or retrospective review requests including pre pay and post payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents decisions within mandated timeframes and in compliance with applicable regulations or standards. Description Position will be
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