16 to 30 of 263
Building financial models, including but not limited to, projecting a target's future financial performance Deploying different valuation methodologies (DCF, precedent transactions, trading comparables and LBO) and performing various return metric calculations (EPS accretion / dilution analysis and IRR) Preparing executive level communication / summaries that help inform
Posted Today
Gaining exposure to building financial forecasts, including but not limited to, projecting a target's future financial performance Deploying different valuation methodologies (DCF, precedent transactions, trading comparables and LBO) and performing various return metric calculations (EPS accretion / dilution analysis and IRR) Supporting deal teams in financial due diligen
Posted Today
Investigate medium to highly complex cases of fraud, waste, and abuse Detect fraudulent activity by members, providers, employees and other parties against the Company Develop and deploy the most effective and efficient investigative strategy for each investigation Maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case t
Posted 1 day ago
Serve as primary care manager for members with complex medical/behavioral needs Engage members telephonically to complete a comprehensive needs assessment, including assessment of medical, functional, cultural, and socioeconomic (SDOH) domains Develop and implement person centered care plans to address needs including management of chronic health conditions, health promot
Posted 1 day ago
Manage provider complaints to resolution when initiated through regulators including, but not limited to DMS, DOI, or Legislators. Report status updates to DMS and providers, as needed. Implement solutions that educate network on how to resolve issues with UHC resources Proactively partner with providers to identify opportunities for improvement, opportunities for growth
Posted 1 day ago
Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati
Posted 1 day ago
Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica
Posted 1 day ago
Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati
Posted 1 day ago
Small Business Sales (1 100) Create and drive strategies for top specialty producing agencies and Brokers Collaborate with Sales Management and/or Health Plan leadership regarding pipeline, persistency, market objectives and develop competitive strategies with specific Brokers/General Agents Work collaboratively with AE/RAC/SAE to support sales, product and process educat
Posted 1 day ago
Compile and/or integrate information needed to complete reports and documents Prepare and/or format office documentation (e.g., letters; spreadsheets; reports) needed for various audiences (e.g.,clients; executives; internal business partners) Review prepared documents to ensure accuracy and quality, and revise as needed Post relevant documentation (e.g., meeting notes; P
Posted 1 day ago
Synthesize and forecast industry trends, customer needs, competitive threats, survey insights, member experience best practices and internal and competitive performance to design industry leading customer service and health plan improvement strategies Serve as a subject matter expert in CAHPS measure specifications, member pain points, survey strategy and business operati
Posted 1 day ago
Analyze, review, forecast and trend complex data Present analysis and recommendations for operational and business review/planning Support short and long term operational/strategic business activities through analysis Develop, recommend and implement business solutions through research and analysis of data and business processes This is a complex, fast paced, matrixed env
Posted 1 day ago
Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re
Posted 1 day ago
Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re
Posted 1 day ago
Proficient in review of medical records and the ability to identify pertinent information on which to base appropriate clinical decisions. Document relevant chronology of case review and provide rational for determination Plan, prioritizes, organizes and completes work to meet established objectives. Excellent verbal and written communication skills with internal and exte
Posted 1 day ago
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