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Results based on filters ( 35 jobs found )

Supervisor Member Services

Highmark Inc.
West Virginia
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Company : Highmark Inc. Job Description : JOB SUMMARY This job is ...
Details
Summary
About the job:
responsible for supervising member service call center and ensuring timely, professional, and courteous responses to all customer inquiries and complaints, appropriately referring inquiries to other areas as necessary for resolution. Investigate escalated member inquiries. The incumbent may be required to make routine medical approval decisions. This role requires you to reside within the state of West Virginia. ESSENTIAL RESPONSIBILITIES - Manage the departmental operations and day-to-day functions. - Handle escalated calls...
Location:
West Virginia
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Highmark Inc.
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Contract Analyst

Highmark Inc.
Pittsburgh, PA
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Company : Highmark Inc. Job Description : JOB SUMMARY This job manages ...
Details
Summary
About the job:
contracts including negotiations, contract development, contract renewal, and financial reimbursement. Acts as the intermediary between the organization and outside entity. Responds to contractual and payment issues both internally and externally. Ensures compliance with contractual terms. ESSENTIAL RESPONSIBILITIES - Monitor activities by tracking the specific terms of each contract and maintaining some mechanism for monitoring and documenting compliance with those terms. Perform special studies/audits, coordinating...
Location:
Pittsburgh, PA
Job Type:
Full-Time
Contract
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
Highmark Inc.
Certifications / Licenses:
Certified Public Accountant
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Executive Client Manager - PA

Highmark Inc.
Pittsburgh, PA
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Company : Highmark Inc. Job Description : JOB SUMMARY This job is ...
Details
Summary
About the job:
responsible for managing a book of business and the business relationship as a strategic consultant for existing accounts directly or through intermediaries. The incumbent is responsible for renewing accounts and selling new products and services to existing accounts to ensure retention and growth of profitable business. Manages key groups with contracts generally greater than 30,000. The incumbent is responsible for complex accounts that are multi-state and non-standard and complex, involving multiple, custom products and...
Location:
Pittsburgh, PA
Job Type:
Full-Time
Permanent
Occupation:
Sales Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Highmark Inc.
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Investigations Consultant

Highmark Inc.
Pittsburgh, PA
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Company : Highmark Inc. Job Description : JOB SUMMARY This job is ...
Details
Summary
About the job:
responsible for development and implementation of strategic audit plans utilizing numerous inputs including contracts, industry trends and revenue maximization schemes. The incumbent will also work with other audit team members and external vendors to develop specific auditing techniques to identify overbilling and potential recoveries/ savings. Incumbent is responsible for coordinating and overseeing all aspects of cases that are referred to law enforcement agencies. This oversight includes maintaining and developing a...
Location:
Pittsburgh, PA
Job Type:
Full-Time
Permanent
Occupation:
Fraud Examiners, Investigators and Analysts
Career Level / Education:
Bachelor's degree
Salary:
Middle Income Jobs ($30K-$49K)
From:
Highmark Inc.
Certifications / Licenses:
Certified Pension Consultant
Certified Fraud Examiner
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

VP Reimbursement, Provider & Network Programs

Highmark Inc.
Pittsburgh, PA
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Company : Highmark Inc. Job Description : JOB SUMMARY This role is ...
Details
Summary
About the job:
accountable for any program or strategic tactic to drive provider performance in the domains of reimbursement and network programs. Specifically, the incumbent will lead the strategy and creation of value-based reimbursement (VBR) & risk programs, as well as the overall provider inventive and payment strategy. The role also leads the strategy and creation of provider network designs and programs. The incumbent is responsible for understanding regulatory trends and competitive advantages / disadvantages when formulating...
Location:
Pittsburgh, PA
Job Type:
Full-Time
Permanent
Occupation:
General and Operations Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Highmark Inc.
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Case Manager Long-term Care ( New Castle County, Delaware)

Highmark Inc.
Delaware
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Company : Highmark Inc. Job Description : JOB SUMMARY This job serves as the ...
Details
Summary
About the job:
single point of contact for members to coordinate all of the member’s care needs across the various service delivery systems and community supports. This is a full-time community-based position requiring frequent travel within the assigned territory in DE. A significant portion of this role involves working directly with members in their homes and also requires providing case management services within nursing facility settings. The incumbent will travel to members’ homes, nursing facilities, and other...
Location:
Delaware
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Highmark Inc.
Certifications / Licenses:
Licensed Clinical Social Worker
Certified Case Manager
Licensed Master Social Worker
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

VP Medicaid Markets CEO - PA

Highmark Inc.
Pittsburgh, PA
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Company : Highmark Inc. Job Description : JOB SUMMARY This job leads the ...
Details
Summary
About the job:
overall performance of a Medicaid plan, for quality of care and service as well as financial performance. The incumbent delivers the revenue and operating gains for this market. They are accountable for establishing and maintaining strategic relationships within the assigned state, the care provider partners, key vendors, and the community at-large. The incumbent develops the strategic direction and insurers it’s execution for revenue management, federal and state regulatory and contract compliance, care management, and...
Location:
Pittsburgh, PA
Job Type:
Full-Time
Permanent
Occupation:
Compliance Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Highmark Inc.
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Case Manager Long-term Care - RN (New Castle County, Delaware)

Highmark Inc.
Delaware
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Company : Highmark Inc. Job Description : JOB SUMMARY This job serves as the ...
Details
Summary
About the job:
single point of contact for members to coordinate all of the member’s care needs across the various service delivery systems and community supports. This is a full-time community-based position requiring frequent travel within the assigned territory in DE. A significant portion of this role involves working directly with members in their homes and also requires providing case management services within nursing facility settings. The incumbent will travel to members’ homes, nursing facilities, and other...
Location:
Delaware
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Highmark Inc.
Certifications / Licenses:
Licensed Clinical Social Worker
Certified Case Manager
Licensed Master Social Worker
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

SVP and President Medicaid Business

Highmark Inc.
Pittsburgh, PA
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Company : Highmark Inc. Job Description : JOB SUMMARY The Senior Vice ...
Details
Summary
About the job:
President (SVP) of Medicaid is responsible for the overall strategic direction, financial performance, and operational execution of Highmark's Medicaid & D-SNP business. This executive leadership role requires a deep understanding of the Medicaid landscape, including managed care principles, state and federal regulations, and the needs of vulnerable populations. The SVP of Medicaid will lead a high-performing team to deliver innovative, high-quality, and cost-effective healthcare solutions to Medicaid members, while...
Location:
Pittsburgh, PA
Job Type:
Full-Time
Permanent
Occupation:
Compliance Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Highmark Inc.
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Client Service Manager - National

Highmark Inc.
Pittsburgh, PA
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Company : Highmark Inc. Job Description : JOB SUMMARY This job partners with ...
Details
Summary
About the job:
assigned Client Managers to maintain and grow existing business and ensure that positive account relationships are maintained. The incumbent assists in the preparation of proposals, meeting materials and/or sales collateral during the account renewal process. Evaluates, recommends and implements processes to ensure that account objectives are met. Serves as the sales liaison between group administrators and the Organization's internal departments for problem resolution. The incumbent manages groups and contracts...
Location:
Pittsburgh, PA
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Highmark Inc.
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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