Performs work that is varied and generally administrative or project-oriented for departmental operations. Independently plans, organizes and completes daily work under limited supervision in a manner supportive of a team environment. Requirements Associate’s degree or equivalent
Credentialing Specialist Under the direct supervision of the Manager of Credentialing, responsible for credentialing of providers and associated activities in support of the credentialing process in accordance with established Health Plan credentialing policies following NCQA, Medicare, the
Employer Service Representative The Employer Service Representative (ESR) serves within the Customer Service Department handling complex and escalated phone and written inquiries from internal and external customers. The ESR builds and maintains rapport with members, providers,
Claims Reviewer Under the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviewer must meet or exceed production and quality standards and follow documented policies
Pharmacist Position This is not a remote position - required to work in Wheeling - hybrid. Responsible for comprehensive knowledge of current pharmacotherapeutic principles, disease state and population management to help ensure the delivery of safe,