Job Search
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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 #600Tuesday, September 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 146-1002More
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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
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Tulsa, OK, USA ● Req #576Friday, 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 135-2030More
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Tulsa, OK, USA ● Req #457Friday, September 20, 2024JOB 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 ...Read more about Employee Assistance Program - EAP Counselor 151-2004More
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Tulsa, OK, USA ● Req #513Friday, September 20, 2024JOB 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 ...Read more about Medical Management - Intake Coordinator 145-1021More
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Tulsa, OK, USA ● Req #536Friday, September 20, 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 127-2005More
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Tulsa, OK, USA ● Req #560Friday, September 20, 2024JOB SUMMARY: As a Senior Manager of Software Engineering at CommunityCare, you will play a pivotal role in leading and managing our software engineering teams to deliver innovative solutions that drive the success of our healthcare plan initiatives. You will be responsible for overseeing the development and maintenance of software applications that are critical to our internal operations and our external users. KEY RESPONSIBILITIES: Provide strong leadership and guidance to the software enginee ...Read more about Information Technology - Senior Manager Software Engineering 130-6000More
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Tulsa, OK, USA ● Req #523Friday, September 20, 2024JOB SUMMARY: To provide administrative and clerical support to ensure the efficient operation of the department. KEY RESPONSIBILITIES: •General clerical duties including copying, scanning and faxing. •Develops and maintains files and logs as related to department needs. •Prepares mailings, forms and correspondence. •Complies and provides information as related to department to appropriate personnel. •Performs other duties as assigned. QUALIFICATIONS: •Knowledge of relevant software application ...Read more about Mailroom - Clerical Support Specialist 138-1001More
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Tulsa, OK, USA ● Req #658Thursday, September 19, 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 130-2058More
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Tulsa, OK, USA ● Req #656Thursday, September 19, 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 130-2057More
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Tulsa, OK, USA ● Req #651Thursday, September 19, 2024JOB SUMMARY: The Behavioral Health Clinical Specialist (therapist) is an essential part of our behavioral health team and organization. This licensed behavioral health 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 wel ...Read more about Behavioral Health - Behavioral Health Clinical Specialist (LPC/LCSW) 150-2005More
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Tulsa, OK, USA ● Req #650Thursday, September 19, 2024JOB SUMMARY: Responsible for maintaining all aspects of provider data including provider directory, files and backup/support for directory audits. Providing departmental support to include answering phones and additional clerical duties. Assists with process improvement activities related to the flow of provider data. KEY RESPONSIBILITIES: Provides efficient maintenance of provider data and provider directory. Provides support for audits. Maintains and distributes reports. Answering phones ...Read more about Provider Services - Provider Data Specialist 115-1007More
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Tulsa, OK, USA ● Req #645Thursday, September 19, 2024JOB 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 ...Read more about Medical Management - Intake Coordinator 145-2024More
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Tulsa, OK, USA ● Req #643Thursday, September 19, 2024JOB 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 producti ...Read more about Enrollment Services - Enrollment Processor 160-1017More
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Tulsa, OK, USA ● Req #628Saturday, September 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