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The individual in this position provides a high level of pharmaceutical based medical knowledge in order to support the effective administrative and utilization management of all corporate pharmacy benefit programs offered under all prescription drug riders, major medical benefits and some basic benefits. Primary Responsibility Coordinates certain prior authorization/non formulary requests; ensure
Posted 1 day ago
Provides comprehensive care management services for external clients and for all lines of business in conjunction with strategic business partnerships, all applicable regulatory guidelines and any applicable specific state requirements. Comprehensive care management functions include Utilization Management, Case Management, Disease Management and Cost Containment, providing the continuum of health
Posted 5 days ago
Responsible for maintaining integrity and quality of data and assuring data conformity meets operational requirements and goals. Provides direction and coaching for less experienced Data Analysts. Acts as a central resource for data administration. Researches internal and external data sets, validate the data and determine the correct course of action in case of data discrepancy/anomalies. Primary
Posted 5 days ago
BlueCross BlueShield of Western New York, headquartered in Buffalo, is one of New York's leading health care companies, providing high quality coverage and innovative wellness solutions to members throughout our region. We strive to impact our communities with positive and healthy changes. We're looking for team spirited, motivated, and enthusiastic individuals to create opportunities to help us s
Posted 6 days ago
The Test Automation Engineer II is responsible for the design, planning, and creation of automated functional and performance tests. The Test Automation Engineer will possess the necessary skills and experience to architect and develop automated test infrastructure and define test development needs and procedures. Primary Responsibility Creates, maintains and executes Automated Functional Test Pla
Posted 6 days ago
The Senior HR Analyst evaluates, analyzes, designs, and maintains Human Resources Information Systems (HRIS). The incumbent assists in identifying new HR needs and process optimizations. The Analyst continuously creates new and develops existing metrics and analytics to fill business needs; as well as leads or participates in projects that involve technology, data or other HRIS related topics. Pri
Posted 12 days ago
The Administrative Assistant provides a range of administrative support services to the Finance leadership team, which includes the Corporate Controller and Director of FP&A and Treasury. Responsibilities also include direct support for Finance staff to promote efficient delivery of services and, where applicable, effective management of the Finance department. She/he maintains high standards of p
Posted 14 days ago
Provides support to management and departmental operations through conducting and organizing administrative duties and activities. Primary Responsibility Functions as first line customer service; greeting and assisting visitors, answering telephone calls, answering questions, referring or routing calls Greets visitors, assists with general inquires, refers to appropriate individual/department Comm
Posted 14 days ago
Provides quality customer service within a high volume contact center to include providing complete, accurate and timely responses to inquires from subscribers, members and providers; adjusts claims in accordance with subscriber contracts Primary Responsibility Responds to and resolves inquires from subscribers, members, providers, facilities, other Blues plans Communicates and interacts with cust
Posted 15 days ago
Provides quality customer service within a high volume contact center to include providing complete, accurate and timely responses to inquires from subscribers, members and providers; keys, processes and adjusts claims in accordance with the Service Benefit plan (Federal Employee contract Primary Responsibility Responds to and resolves inquires from subscribers, members, providers, facilities Comm
Posted 15 days ago
Provides quality customer service within a high volume contact center to include providing complete, accurate and timely responses to inquires from subscribers, members and providers; keys, processes and adjusts claims in accordance with the Service Benefit plan (Federal Employee contract Primary Responsibility Responds to and resolves inquires from subscribers, members, providers, facilities Comm
Posted 15 days ago
The Risk Adjustment Coding Outreach Educator works under the direct supervision of the Supervisor, Risk Revenue Operations and collaboratively with others in the organization, including the medical coders, risk specialist, analysts, provider account managers, external vendors, contracted providers and their office staff. The incumbent's primary responsibilities are to code, abstract and analyze ou
Posted 20 days ago
Provides quality customer service within a high volume contact center to include providing complete, accurate and timely responses to inquires from subscribers, members and providers; keys, processes and adjusts claims in accordance with the Service Benefit plan (Federal Employee contract Primary Responsibility Performs other duties of a similar nature that are not inconsistent with this position
Posted 22 days ago
Responsible for negotiating contracts with third party vendors with assistance from the Director. Responsible for managing research projects to allocated budget. External Contacts vendors Experience or related area. Requires a minimum of three (3) years of professional level market research experience. Education Required Education Bachelors Degree (Business Admin.,Marketing) Working Conditions Mus
Posted 22 days ago
The intermediate level Software Developer II position will leverage previous education, skills and experience as part of the Application Development organization. The incumbent will create new technology solutions while also being called upon to modify existing business applications. The role will focus on business outcomes while collaborating with IT peers and business partners. Software Develope
Posted 22 days ago
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