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Tulsa, OK, USA ● Req #676Thursday, October 17, 2024JOB SUMMARY: The Manager of Risk Adjustment is responsible for directing a team of data analysts in providing analytical support and various cost and quality metrics to both internal and external customers. Facilitates submission of encounter records to regulatory agencies, resolution of rejected records and reconciliations. Facilitates submission of data for CMS and other regulatory audits. Oversees calculation and tracking of risk factors and analyzes trends in risk scores. Performs analys ...Read more about Reporting - Manager Data Risk Adjustment 135-5004More
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Tulsa, OK, USA ● Req #668Thursday, October 17, 2024JOB SUMMARY: As a Financial Analyst specializing in modeling and process improvement, you will play a critical role in enhancing financial performance and operational efficiency within the organization. Your primary responsibilities will revolve around financial modeling, analysis, and the implementation of process improvements to drive strategic decision-making and optimizebusiness processes. KEY RESPONSIBILITIES: Financial Modeling: Develop and maintaincomplex financial models to an ...Read more about Financial Planning & Analysis - Financial Analyst 127-2004More
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Tulsa, OK, USA ● Req #679Thursday, October 17, 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 (Part Time) 105-1070More
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Tulsa, OK, USA ● Req #680Thursday, October 17, 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 (Part Time) 105-1069More
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Tulsa, OK, USA ● Req #670Tuesday, October 15, 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 Marketing - Sales & Retention Support Analyst 110-1012More
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Tulsa, OK, USA ● Req #671Tuesday, October 15, 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 #672Tuesday, October 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 105-1020More
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Tulsa, OK, USA ● Req #628Monday, October 14, 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 176-1008More
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Tulsa, OK, USA ● Req #660Thursday, October 10, 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 105-1057More
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Tulsa, OK, USA ● Req #659Thursday, October 10, 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 105-1002More
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Tulsa, OK, USA ● Req #652Thursday, October 10, 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 105-1048More
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Tulsa, OK, USA ● Req #632Thursday, October 10, 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 9am-1pm/10am-2pm or Weekends) 105-1067More
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Tulsa, OK, USA ● Req #646Thursday, October 10, 2024JOB SUMMARY: Responsible for providing daily guidance, instruction and training to inspire the team to perform at their optimum. Will work directly with Customer Service Supervisor to create a team that works efficiently together to maximize the team’s potential. Also responsible for interacting with members, providers and other internal customers to resolve elevated problems of a complex nature. May serve as a liaison between Customer Service and other departments. Assists Customer Service ...Read more about Customer Service - Customer Service Team Lead 105-1047More
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Tulsa, OK, USA ● Req #633Thursday, October 10, 2024JOB SUMMARY: Responsible for completing out-bound calls and other member outreach opportunities to select members and documenting efforts. This role spends 100% of time on quality program activities. May require extended, or multiple, phone calls to members. May require work on additional projects as directed. KEY RESPONSIBILITIES: Contact members selected for intervention. Assist members with developing a plan to resolve identified HEDIS gaps in care, setting up appointments, getting to ...Read more about Quality Improvement - Member Engagement Specialist 195-1008More
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Tulsa, OK, USA ● Req #667Monday, October 7, 2024JOB SUMMARY: The Customer Service Supervisor will build a strong team of Customer Service Representatives and shape staff behaviors to accomplish desired results to meet the expectations and needs of our members, providers and internal customers. You will be responsible for providing ongoing coaching to inspire our Customer Service Representatives to deliver exceptional customer service as well as coaching to develop CSRs in their current role or to take on additional responsibilities. You will ...Read more about Customer Service - Supervisor Customer Service 105-4001More
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Tulsa, OK, USA ● Req #666Monday, October 7, 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 105-1025More
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Tulsa, OK, USA ● Req #599Saturday, September 28, 2024JOB SUMMARY: Responsible for performing general clerical functions, departmental customer service and support. KEY RESPONSIBILITIES: Provide clerical support to department including copies, filing, mailing or faxing as directed. Process all incoming departmental mail and documents. Responsible for file retention, relocation and shredding. Responsible for departmental document imaging, auditing and indexing of imaged files. Assist other departmental members as needed and phone back-up. Perfo ...Read more about Provider Services - Support Specialist 115-1020 (part time)More
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Tulsa, OK, USA ● Req #504Saturday, September 28, 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 160-1003More
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Tulsa, OK, USA ● Req #647Friday, September 27, 2024The Medical Review Supervisor is responsible for overseeing activities and personnel involved in the day to day operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing and monitoring functions aimed at identifying areas of risk and/or potential fraud, waste and abuse, as it relates to provider billing practices. KEY RESPONSIBILITIES: Provides technical expertise to Medical Review (MRE) staff including analysis, problem solving, and ...Read more about Configuration - Supervisor Medical Review 200-4004More
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Tulsa, OK, USA ● Req #638Thursday, September 26, 2024JOB SUMMARY: The Software Engineer will build out the next generation of our platform. As a Software Engineer, you are expected to work independently, and within teams, leading the development of software features. You will be involved with the early stages of mentoring other team members and helping with identifying process improvements for the team. KEY RESPONSIBILITIES: •Implements features of the application and is proficient in one or more of the feature or components. •Leads independent ...Read more about Information Technology - Software Engineer 130-2048More
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JOB SUMMARY: The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. 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: Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making i ...Read more about Claims HMO - Claims Examiner_140-1006More
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Tulsa, OK, USA ● Req #661Tuesday, September 24, 2024JOB SUMMARY: Responsible for all inquiries from members and providers seeking resolution through the grievance and appeals process. KEY RESPONSIBILITIES: Investigates member complaints and communicates resolution to member (or authorized representatives) for all lines of business in accordance with CommunityCare’s grievance procedures. Investigates; prepares case files and presents cases for medical and/or administrative review. For all lines of business for non-complex post-service claims ...Read more about Quality Improvement - Grievance & Appeals Coordinator I_195-1007More
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Tulsa, OK, USA ● Req #579Friday, September 20, 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
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Tulsa, OK, USA ● Req #578Friday, September 20, 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 115-1005More
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Tulsa, OK, USA ● Req #575Friday, September 20, 2024JOB SUMMARY: The Senior Health Data Analyst provides the analytical support for Executives and all departments including analysis, pricing, capitation, network, and provider specific reporting. Analytical support includes programming customer-based specifications, producing appropriate statistics, reports, and presentations, analyzing results and impacts, and generating written reports with recommendations and conclusions. The Senior Analyst works with data in company and other databases, data ...Read more about Reporting - Senior Health Data Analyst 135-2031More