CommUnityCare
JOB SUMMARY: The UI/UX Developer is responsible for the development of front end portals using the Angular framework. The UI/UX Developer will be responsible for collaborating with the User Experience team to ensure cohesive branding across company portals and interfaces.…
JOB SUMMARY: The UI/UX Developer is responsible for the development of front end portals using the Angular framework. The UI/UX Developer will be responsible for collaborating with the User Experience team to ensure cohesive branding across company portals and interfaces.…
JOB 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.…
JOB SUMMARY: The Provider Services Representative supports the internal infrastructure of the Provider Relations department by managing provider lifecycle processes and maintaining operational efficiency. This administrative role ensures timely and accurate updates to provider records, coordinates credentialing and termination workflows,…
JOB SUMMARY: Oversee all aspects of operations of the Pharmacy department including delivery of pharmacy benefits, network, administration, budgeting, reporting, and claims adjudication. Supervise all employees of the Pharmacy department. Provide clinical pharmacy direction for the health plan, including but…
The 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…
JOB SUMMARY: The Technical Product Owner (TPO) serves as the bridge between business needs and technical implementation, ensuring that product development aligns with strategic objectives and delivers measurable value. The TPO partners closely with engineering, architecture, and business stakeholders to…
JOB SUMMARY: The Technical Product Owner (TPO) serves as the bridge between business needs and technical implementation, ensuring that product development aligns with strategic objectives and delivers measurable value. The TPO partners closely with engineering, architecture, and business stakeholders to…
JOB 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.…
JOB SUMMARY: Responsible for marketing the company’s commercial products to prospective clients and for assisting in the servicing and retaining existing accounts. KEY RESPONSIBILITIES: Identifies and sells lines of business directly to potential corporate clients and through an assigned distribution…
JOB SUMMARY: The Analyst provides analytical support for all departments, including analysis, pricing, capitation, network and provider specific reporting. Analytical support includes creating and executing beginner and intermediate level reports and programs and programming modifications to previously written reports. The…
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…
JOB SUMMARY: The Director of Risk Adjustment is responsible for the strategic design, implementation, and oversight of CCOK’s risk adjustment program for both ACA and Medicare Advantage businesses. This individual will coordinate with various areas including IT, Healthcare Economics, Finance,…
JOB SUMMARY: The Provider Performance Specialist plays a key role in strengthening relationships between the health plan and its provider network by offering education, support, and guidance on performance improvement initiatives. This position collaborates closely with internal clinical and reporting…
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.…
JOB SUMMARY: Responsible for providing customer service support for behavioral health benefits, directing members to appropriate in network services, processing prior authorizations according to CMS and State regulations, sending out provider faxes well as member letters, and resolving behavioral health…
JOB SUMMARY: This position works under the Marketing Department’s Broker Relations and Market Development team. Employee must work collaboratively across all lines of business in achieving annual membership goals by promoting the CommunityCare brand and mission to broker partners (broker…