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  • Tulsa, OK, USA ● Req #577
    Tuesday, June 25, 2024
    JOB SUMMARY: The Behavioral Health Clinical Specialist is an essential part of our behavioral health team and organization. This clinician will be instrumental in ensuring the appropriate utilization of behavioral health services for our members while upholding the highest standards of care and efficiency. This clinician will be responsible for clinical review and assessment of care for mental health and substance abuse services for the health plan. As well as monitoring and making level of car ... More
  • Tulsa, OK, USA ● Req #580
    Tuesday, June 25, 2024
    JOB SUMMARY: Member Advocate II will provide exceptional service to our members that require customer service assistance in person at our Senior Center.  Generally, the Member Advocate is called upon to listen to members, empathize with them and then work to solve issues they are unable to solve on their own regarding their health insurance or healthcare.  The Advocates are called on to handle the more complex problems faced by our members or that may be reported to us by our various regulatory ... More
  • Tulsa, OK, USA ● Req #578
    Tuesday, June 25, 2024
    JOB 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, ... More
  • Tulsa, OK, USA ● Req #549
    Monday, June 24, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #575
    Monday, June 24, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #576
    Monday, June 24, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #552
    Monday, June 24, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #457
    Monday, June 24, 2024
    JOB SUMMARY: Responsible for conducting clinical behavioral health assessments and/or brief counseling of clients. Make referrals and conducts referral assessments, and follow-up. Provide training and/or workshops to EAP companies.   KEY RESPONSIBILITIES: Conducts clinical behavioral health assessments and/or brief counseling of clients and makes referrals to contracted providers for select diagnoses. Monitor and manage affiliate cases to insure appropriate utilization of the EAP.  Conducts ... More
  • Tulsa, OK, USA ● Req #556
    Friday, June 21, 2024
    JOB SUMMARY: Responsible for training of all non-exempt personnel in the Claims, Enrollment, and Customer Service departments 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 RESPONSIBIL ... More
  • Tulsa, OK, USA ● Req #511
    Friday, June 21, 2024
    JOB SUMMARY: This position is responsible for maintaining the entry and maintenance of the customer database. Maintains customer files and data according to regulations.   KEY RESPONSIBILITIES: Generates customer correspondence and distributes information. Creates and maintains customer eligibility in the database. Reviews information to determine requirements. Reviews and processes enrollment information to ensure compliance with all regulations. Accountable for meeting quality and production ... More
  • Tulsa, OK, USA ● Req #513
    Friday, June 21, 2024
    JOB SUMMARY: This non-clinical position supports the department by performing a broad range of clerical duties.     KEY RESPONSIBILITIES: Prepares correspondence to members, providers, and facilities. Provides follow up with providers and members as needed. Reviews service requests for completeness of information. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers non-clinical questions and takes information, or refers callers to appropriate ... More
  • Tulsa, OK, USA ● Req #518
    Friday, June 21, 2024
    JOB SUMMARY: This non-clinical position supports the department by performing a broad range of clerical duties.     KEY RESPONSIBILITIES: Prepares correspondence to members, providers, and facilities. Provides follow up with providers and members as needed. Reviews service requests for completeness of information. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers non-clinical questions and takes information, or refers callers to appropriate ... More
  • Tulsa, OK, USA ● Req #519
    Friday, June 21, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #493
    Wednesday, June 19, 2024
    JOB SUMMARY:  Responsible for performing health intake functions, directing members to services needed.  KEY RESPONSIBILITIES:  •Verifies member eligibility, line of business and network affiliations for members and providers. Determines if the call is clinical and requires transfer to a clinical staff person. Will inform callers, including members, facility personnel, physicians, or other health care professionals of the utilization requirements and procedures.  •Makes initial referrals that ... More
  • Tulsa, OK, USA ● Req #204
    Wednesday, June 19, 2024
    JOB SUMMARY: The Sr. Software Engineer will build out the next generation of our platform. As a Sr. Software Engineer, you are expected to work independently, and within teams, leading the development of software features. Ability to prioritize well, communicate clearly, have a consistent track record of delivery, and excellent software engineering skills. You will be involved with mentoring other team members and helping with identifying process improvements for the team. KEY RESPONSIBILITIES:D ... More
  • Tulsa, OK, USA ● Req #564
    Monday, June 17, 2024
    JOB SUMMARY: The Analyst II provides analytical support for all departments, including analysis, pricing, capitation, network and provider specific reporting. Analytical support includes creating and executing intermediate to advanced level reports and programs and programming modifications to previously written reports. The Analyst II will collaborate with key stakeholders and determine the needed result including any special specifications. The Analyst II will work with several databases to p ... More
  • Tulsa, OK, USA ● Req #566
    Monday, June 17, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #565
    Monday, June 17, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #573
    Monday, June 17, 2024
    JOB SUMMARY: The Staff Attorney is a dynamic and motivated individual that serves as an integral part of our legal team. This role will report directly to the General Counsel and provide legal and regulatory analysis to ensure compliance with laws, rules, regulations, and industry standards.  This individual has a keen interest in legislative and regulatory affairs, strong legal research and writing skills and an excellent ability to identify, analyze, and communicate complex legal scenarios to ... More
  • Tulsa, OK, USA ● Req #538
    Sunday, June 16, 2024
    JOB SUMMARY: The Senior 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.  The Senior Claims Examiner will generally handle claims involving multiple lines of business or has been permanently assigned additional respo ... More
  • Tulsa, OK, USA ● Req #536
    Sunday, June 16, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #535
    Sunday, June 16, 2024
    JOB SUMMARY: Responsible for developing, implementing, monitoring, and evaluating on-going training programs for Medical Management.  Assist Medical Management Supervisor with training clinical staff. Identify training opportunities through the quality audit review process and incorporating training in daily stand up, team and monthly staff meetings. Perform quality review on all operational data entry on clinical personnel and select data criteria for Medical management as it relates to regulat ... More
  • Tulsa, OK, USA ● Req #541
    Sunday, June 16, 2024
    JOB 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 Concurrent Review Team.   KEY RESPONSIBILITIES: Performs utilization review of inpatient, post-acute, outpatient and ancillary services. Determines medical neces ... More
  • Tulsa, OK, USA ● Req #544
    Sunday, June 16, 2024
    JOB SUMMARY: The Behavioral Health Clinical Specialist is an essential part of our behavioral health team and organization. This clinician will be instrumental in ensuring the appropriate utilization of behavioral health services for our members while upholding the highest standards of care and efficiency. This clinician will be responsible for clinical review and assessment of care for mental health and substance abuse services for the health plan. As well as monitoring and making level of car ... More
  • Tulsa, OK, USA ● Req #540
    Sunday, June 16, 2024
    JOB SUMMARY: This position is a part of a team that provides support to Brokers and Employer Groups via email and phone communication.  Support is provided for billing/invoice inquiries, eligibility inquiries, claims inquiries, and benefit verification. As a Marketing Connection Liaison, you are expected to foster a member centric, performance driven attitude to uphold our culture and reputation for caring for our members like no other health plan can or does.   KEY RESPONSIBILITIES: Monitor a ... More