Job Search
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Tulsa, OK, USA ● Req #549Thursday, July 25, 2024JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will ...Read more about Customer Service - Customer Service Representative 105-1012More
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Tulsa, OK, USA ● Req #565Thursday, July 25, 2024JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will ...Read more about Customer Service - Customer Service Representative 105-1038More
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Tulsa, OK, USA ● Req #610Thursday, July 25, 2024JOB SUMMARY: Responsible for performing a broad range of quality related activities associated with all aspects of performance improvement projects in accordance with Federal and State regulations and URAC accreditation standards. This position is also accountable for evaluating potential quality of care issues companywide. This role spends 100% of time on quality program activities. KEY RESPONSIBILITIES: Collaborates on review and resolution of all alleged clinical quality of care issues s ...Read more about Quality Improvement - Clinical Healthcare Coordinator 195-2010More
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Tulsa, OK, USA ● Req #609Thursday, July 25, 2024JOB SUMMARY: The Stars Medication Adherence Specialist implements, tracks and supports new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for providers and members in accordance with prescribed quality standards; conducts data collection, tracking and monitoring for key performance measurement activities at the provider and member level. Provides ongoing practice support and sustains the partnership. Improves the understanding and ...Read more about Quality Improvement - STARS Medication Adherence Specialist 195-1031More
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Tulsa, OK, USA ● Req #606Thursday, July 25, 2024JOB SUMMARY: This role is an Atlassian Business Analyst focused on building out a new JIRA ITSM environment and automation. The Administrator will be working with the team members to roll out changes to our infrastructure. KEY RESPONSIBILITIES: Create comprehensive JIRA workflows including project workflows, screen schemes, permission schemes, notification schemes etc. Build customized solutions to extend the functionality of Atlassian JIRA using third party add-ons. Set up reports, dashboard ...Read more about Information Technology - JIRA Administrator 130-1019More
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Tulsa, OK, USA ● Req #605Thursday, July 25, 2024JOB SUMMARY: Responsible for selling Medicare products and Individual Health Plan products via telemarketing calls and person-to-person meetings, including seminars. KEY RESPONSIBILITIES: Discuss products and benefits with eligible beneficiaries on a person to person basis in various settings. Makes outbound calls, as allowed, to prospects to answer questions and to schedule further sales follow up calls. Receives inbound calls from prospective enrollees, answer questions about company pr ...Read more about Individual Marketing - Health Plan Consultant 176-1011More
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Tulsa, OK, USA ● Req #602Thursday, July 25, 2024JOB SUMMARY: Responsible for supervising and coordinating daily workflow and leadership of staff. Activities include developing operating procedures and managing personnel and resources. KEY RESPONSIBILITIES: Serves as a resource to the department staff by providing technical direction and resolving workflow problems or improvement opportunities within the department. Assesses individual workload and staffing patterns. Selects, assigns, and evaluates personnel, and recommends or initiates ass ...Read more about Medical Management - Supervisor Utilization Management 145-4003More
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Tulsa, OK, USA ● Req #600Thursday, July 25, 2024JOB SUMMARY: Responsible for providing technical and customer service support for pharmacy benefits, processing prior authorizations according to CMS and State regulations, and resolving pharmacy related complaints. KEY RESPONSIBILITIES: Telephone support for pharmacies and members related to pharmacy benefits for the HMO product. Provides resolution for various types of phone calls including, but not limited to referral, authorization, and step therapy protocols between physicians, pharmac ...Read more about Pharmacy - Pharmacy Technical Support Specialist 146-1002More
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Tulsa, OK, USA ● Req #607Thursday, July 25, 2024JOB SUMMARY: Primarily responsible for contracting, orientation and ongoing education of physicians, physician office staffs, hospitals and other providers regarding the policies and procedures of CommunityCare Managed HealthCare Plans. Serves as the liaison between the provider community and the health plan. KEY RESPONSIBILITIES: Conducts educational and credentialing PCP and appropriate SCP office site visits according to established standards. Provides ongoing education, develops agendas, ...Read more about Provider Services - Provider Services Representative 115-1001More
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Tulsa, OK, USA ● Req #604Thursday, July 25, 2024JOB SUMMARY: Responsibilities include performing credentialing activities consistently for each applicant in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans of Oklahoma Policy and Procedure Manual. KEY RESPONSIBILITIES: Responsible for initial assessment of applications and other data for accuracy and completeness and contacting applicants or other outside resources to resolve questions or to obtain missing inf ...Read more about Provider Services - Credentialing Specialist 115-1021More
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Tulsa, OK, USA ● Req #601Thursday, July 25, 2024JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team. KEY RESPONSIBILITIES: Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute servi ...Read more about Medical Management - Utilization Management RN 145-2022More
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Tulsa, OK, USA ● Req #598Thursday, July 25, 2024JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team. KEY RESPONSIBILITIES: Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute service ...Read more about Medical Management - Utilization Management RN 145-2046More
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Tulsa, OK, USA ● Req #475Wednesday, July 24, 2024JOB SUMMARY: Responsible for providing technical and customer service support for pharmacy benefits, processing prior authorizations according to CMS and State regulations, and resolving pharmacy related complaints. KEY RESPONSIBILITIES: Telephone support for pharmacies and members related to pharmacy benefits for the HMO product. Provides resolution for various types of phone calls including, but not limited to referral, authorization, and step therapy protocols between physicians, pharmac ...Read more about Pharmacy - Pharmacy Technical Support Specialist 146-1031More
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Tulsa, OK, USA ● Req #597Wednesday, July 24, 2024JOB SUMMARY: Responsible for all written inquiries from members seeking resolution through the grievance and appeals process. KEY RESPONSIBILITIES: Researches member issues and prepares grievance and appeals information for each level of the appeal process. Responsible for adhering to established grievance and appeals timeframes. Assures compliance with Federal, State and Accreditation regulations. Receives and responds to member and/or provider written and oral complaints and requests i ...Read more about Quality Improvement - Grievance & Appeals Coordinator 195-1025More
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Tulsa, OK, USA ● Req #430Monday, July 22, 2024JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will b ...Read more about Customer Service - Customer Service Representative 105-1016More
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Tulsa, OK, USA ● Req #587Tuesday, July 16, 2024JOB SUMMARY: This position is a part of a team that provides support to our sales and retention reps in the form of data gathering, data entry and analysis, proposal and financial exhibit development, and coordinates with internal and external customers to install and renew employer group benefits. KEY RESPONSIBILITIES: Monitor email and respond to Request for Proposals (RFPs): Gather benefit information from a variety of sources, coordinates response, inputs data and maintains all appropria ...Read more about Individual Marketing - Sales & Retention Support Analyst 176-1010More
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Tulsa, OK, USA ● Req #591Tuesday, July 16, 2024JOB SUMMARY: Responsible for supervising and coordinating daily workflow and leadership of staff. Activities include developing operating procedures and managing personnel and resources. KEY RESPONSIBILITIES: Serves as a resource to the department staff by providing technical direction and resolving workflow problems or improvement opportunities within the department. Assesses individual workload and staffing patterns. Selects, assigns, and evaluates personnel, and recommends or initiates ass ...Read more about Medical Management - Supervisor Concurrent Review 145-4004More
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JOB SUMMARY: The Stars Manager will oversee and drive the health plan to achieve optimal star ratings for Medicare and Marketplace related product lines. The Stars Manager will assist in developing strategy and translate strategy and goals into execution within a matrixed organizational environment. Overall percentage of responsibilities pertaining to quality activities for this job role is 100%. KEY RESPONSIBILITIES: Work across the health plan and with provider leadership to develop an ...Read more about Quality Improvement - Manager STARS 195-5003More
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Tulsa, OK, USA ● Req #594Tuesday, July 16, 2024JOB SUMMARY: Responsible for working with members, providers, and other multidisciplinary team members to facilitate, collaborate and coordinate healthcare for members identified with complex healthcare needs. Work with members throughout the continuum of care to enhance the members healthcare experience and assist with the provision of cost-effective healthcare options. KEY RESPONSIBILITIES: Complete clinical assessments of members requiring case management oversite to assist with fa ...Read more about Medical Management - Case Management Specialist 145-2029More
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Tulsa, OK, USA ● Req #592Tuesday, July 16, 2024JOB SUMMARY: Responsible for processing reports, reconciling transactions and updating the system. Create and maintain customer eligibility in the company database, generate customer correspondence for new packets, assemble and distribute customer handbooks and process notifications. KEY RESPONSIBILITIES: Create and maintain customer eligibility in the database. Generate appropriate correspondence and ID cards. Review and process files and reports. Mail customer notices and requests for ...Read more about Enrollment Services - Enrollment Specialist 160-1004More
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JOB SUMMARY: The Recalculation Examiner is responsible for researching and reprocessing claims that were previously adjudicated and need to be reconsidered for all lines of business. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency. KEY RESPONSIBILITIES: •Researches and reprocesses claims. Includes working with v ...Read more about Claims HMO - Recalculation Examiner 140-1034More
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Tulsa, OK, USA ● Req #593Monday, July 15, 2024JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will ...Read more about Customer Service - Customer Service Representative 105-1033More
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Tulsa, OK, USA ● Req #552Thursday, July 11, 2024JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will ...Read more about Customer Service - Customer Service Representative (M-F 11am-8pm) 105-1014More
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JOB SUMMARY: Responsible for training of all non-exempt personnel in the Claims department on procedures, policies, and mode of operations. This will be done by directly delivering content, developing content for learning, arranging for specialists to deliver content and by measuring the progress of the new hire. The trainer will also assist current employees with residual training needs or training on new processes, procedures or products. KEY RESPONSIBILITIES: • Represent the company in a posi ...Read more about Claims HMO - Trainer 140-1020More
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Tulsa, OK, USA ● Req #579Thursday, June 27, 2024JOB SUMMARY: Responsible for overseeing Care Management and Utilization Management segments of the health care delivery area. This key Executive role provides leadership to a large team of nurses, coordinators, and other personnel to determine approvals/denials of claims as well as direction to several important initiatives as requested. The Senior Medical Director has current, relevant knowledge and/or has current, relevant clinical expertise to manage cases under review, including the current, ...Read more about Medical Management - Senior Medical Director 145-8000More