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Tulsa, OK, USA ● Req #430Sunday, May 12, 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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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 Analyst will collaborate with key stakeholders and determine the needed result including any special specifications. The Analyst will work with several databases to pull and ...Read more about Reporting - Health Data Analyst 135-2016More
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Tulsa, OK, USA ● Req #435Friday, May 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 b ...Read more about Customer Service - Customer Service Representative 105-1064More
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JOB SUMMARY: Provide enterprise-wide system infrastructure support for effective installation/configuration, operation, and maintenance of systems hardware and software. This individual participates in technical research and development to enable continuing innovation within the infrastructure, as well as ensuring that system hardware, operating systems, software systems, and related procedures adhere to organizational values. This individual will assist project teams with technical issues in the ...Read more about Information Technology - Systems AdministratorMore
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Tulsa, OK, USA ● Req #508Thursday, May 9, 2024JOB SUMMARY: The IT Infrastructure Leader will be a strategic leader responsible for overseeing the design, implementation, and management of our healthcare plan's technology infrastructure. This role requires a seasoned professional with a strong background in IT infrastructure management, a deep understanding of healthcare operations, and the ability to drive technological advancements that align with our business goals. KEY RESPONSIBILITIES: Develop and execute a comprehensive infrastructu ...Read more about Information Technology - Information Technology Infrastructure Leader 130-2057More
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JOB SUMMARY: Supports the PMO in project implementations of various enterprise systems including both vendor-provided solutions and applications developed internally. Works directly with business subject matter experts to clearly define project scope, requirements, process flows and other business needs. Communicates effectively with IT and all levels of the organization. KEY RESPONSIBILITIES: Meet with project stakeholders and end users to review, analyze and create detailed documentation ...Read more about Project Management Operations - PMO Analyst 141-2004More
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Tulsa, OK, USA ● Req #419Monday, May 6, 2024JOB SUMMARY: The Manager of Data Reporting and 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. ...Read more about Reporting - Manager Data Reporting & Risk Adjustment 135-5002More
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Tulsa, OK, USA ● Req #499Saturday, May 4, 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. Conducts onboarding calls to new enrollees. Conducts disenrollment survey calls. Rece ...Read more about Individual Marketing - Health Plan Consultant 176-1010More
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Tulsa, OK, USA ● Req #504Saturday, May 4, 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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JOB 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 110-1003More
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Tulsa, OK, USA ● Req #475Saturday, May 4, 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 #522Thursday, May 2, 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 195-1029More
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Tulsa, OK, USA ● Req #530Thursday, May 2, 2024JOB SUMMARY: Responsible for routine and ad hoc department program work pertaining to Grievance and Appeal, Quality Improvement and Medical Review processes for compliance with State, Federal and Accreditation requirements. Monitors to ensure corrective actions have been taken on identified deficiencies. KEY RESPONSIBILITIES: •Plans, organizes, executes and finishes assigned projects associated with program scope. •Conducts routine and ad-hoc monitoring within the department’s operational ar ...Read more about Quality Improvement - QI Program Specialist 195-2001More
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JOB SUMMARY: Responsible for auditing and monitoring company processes. Meets with stakeholders to review corrective action and obtain resolution. Conducts follow-up audits to ensure corrective actions have addressed the root cause to prevent errors from recurring. This position will also provide financial supporting functions to the Director of Pharmacy such as high-alert drug notifications and weekly invoice comparisons. KEY RESPONSIBILITIES: Audit and monitor company processes and busi ...Read more about Pharmacy - Pharmacy Auditor Coordinator 146-1013More
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JOB 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 110-1012More
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Tulsa, OK, USA ● Req #528Thursday, May 2, 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. Handle calls from multiple lines of business, a ...Read more about Customer Service - Senior Customer Service Representative 105-1024More
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Tulsa, OK, USA ● Req #527Thursday, May 2, 2024JOB SUMMARY: Responsible for providing assistance to Executive Level Officer(s) on all scheduling, travel arrangements, meeting preparation, report compilations and special projects. Provides administrative support including all private correspondence, and maintaining confidential files and records forExecutive Level Officer(s). KEY RESPONSIBILITIES: Schedules, coordinates and organizes various meetings for Executive Level Officer(s). Transcribes and prepares correspondence, memorandums, ...Read more about Administration - Executive Administrative Assistant 120-1002More
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JOB 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 #525Thursday, May 2, 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 105-4000More
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Tulsa, OK, USA ● Req #497Thursday, May 2, 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 #355Wednesday, May 1, 2024JOB SUMMARY: Directs the Data Analytics and Reporting, Actuarial, and Underwriting activities of the Company, including product and bid filing activities. Directs the development and analysis of the financial budget, with particular emphasis on premiums, medical costs and provider reimbursement plans. Directs and manages the analysis of medical, pharmacy, and other claim costs and related expenses, including utilization and other trends affecting the company. Directs and manages the estimation ...Read more about Accounting/Finance - Director Actuarial & AnalyticsMore
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Tulsa, OK, USA ● Req #521Monday, April 29, 2024JOB SUMMARY: The Software Engineer II will build out the next generation of our platform. As a Software Engineer II, 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 ind ...Read more about Information Technology - Software Engineer II 130-2051More
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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 ...Read more about Training - Trainer 103-1004More
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Tulsa, OK, USA ● Req #457Thursday, April 25, 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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JOB SUMMARY: The pharmacy intern will provide support to the CommunityCare Pharmacy Department by participating in Medicare Stars, Medication Adherence, and Medication Therapy Management Programs. This position will also provide clinical support for Pharmacy & Therapeutics, Prior Authorizations, and other clinical reviews and research as needed. Effective communication is an important part of this role. The position will be interacting with members, providers, and other departments within Commu ...Read more about Pharmacy- Seasonal Intern - PharmacyMore