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Highmark supervisor benefits

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Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

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This website uses cookies. It uses cookies to ensure that it gives you the best experience on our website. If you continue without agreeing to the cookie conditions, we'll assume that you are happy to receive all cookies on this website. Read more. Covid Vaccination Information Effective November 1, , Highmark Health and its affiliates are requiring all new hires beginning employment to submit proof of full vaccination with one of the three authorized COVID vaccines.

Role model to staff and assist in the day to day activities as needed. Provide service support, training and performance statistics to the team in addition to initiating and implementing process improvements. Perform management functions including, but not limited to: recruitment, selection, orientation, performance measurement; counseling, and performance improvement planning; promotion and termination per corporate policy; and career development and support of staff.

Apply clinical knowledge to work with facilities and providers for care-coordination. May also manage appeals for services denied. Conduct staff meetings that ensure corporate and operational communication supported by meeting minutes; and provide an open forum for issues and problem solving.

Set appropriate targets, measure outcomes and establish plans to negate variances in quality, staff retention, finance and customer satisfaction.

Review and provide input into the oversight of policies and procedures to support regulatory requirements related to Utilization Review. Develop and implement appropriate audit requirements in order to ensure compliance with all staff activity related to Utilization Review.

Ensure that all staff achieves the minimal qualification of their position through ongoing staff development, counsel and motivate employees, evaluate employees, investigate complaints or performance concerns; implement disciplinary action as needed and in consultation with appropriate authority and Employee Relations.

Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. Monitor and manage daily inventories to ensure adequate staffing and resources are available to ensure performance guarantees and established goals are met and maintained.

Monitor calls for quality assurance. Oversee the performance of staff in the administration of service of these programs. Select, train, motivate and develop the staff to enhance their performance and behaviors. Create a work environment that recognizes rewards and motivates employees to continuously improve business processes to add greater value to the products and programs supplied to our members. Manage alternative work schedules and actively guide and coach employees provide career development to maximize performance.

Research quality issues and responds to error assessments. Maintain department logs and documentation, analyze for trends in order to identify and initiate future pro-active measures.

Ensure compliance with all regulatory entities i. Represent the department compliance audits are it relates to the supervisor functions. Subject matter expert for benefit plan and claims processing. Other duties as assigned or requested.

Knowledge of various telephone or call center systems. Knowledge of all company products. Ability to communicate well in person, via phone and via e-mail verbally and written. Ability to clearly articulate processes and procedures to all staff and management personnel.

Ability to communicate, interact, and work effectively and cooperatively with all levels of staff and management teams. Offers Benefits. Supervisor Medicare Process - Call Center. The incumbent works with internal and third-party service partners and vendors to assure accurate processing of enrollment and disenrollment related transactions and agent on-boarding.

Responsible for overseeing call centers responsible for Member Enrollment, Premium Billing, and Broker Support, assuring that all established goal metrics are being met.

Includes monitoring or transactions for timeliness and accuracy. Look for opportunities to improve such processes. To increase member satisfaction ratings, takes the lead in managing preventive service campaigns. Supervisor Utilization Management.

Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Manages areas which may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting.

Utilizes the applicable medical policy and industry standards, and accurately interprets benefits and managed care products. The incumbent is accountable for the oversight; development and maintenance of the department's care management processes. This includes utilization management, strategic planning, care cost initiatives, system development and quality outcomes.

Hires, trains, coaches, counsels, and evaluates performance of direct reports. Also responsible for appropriate application of medical policy and criteria. Works closely with claims, service, Provider Relations, HMS and other departments within the corporation to resolve issues and ensure activities coincide with Utilization Management processes.

May also manage appeals for services denied. Handles and responds to inquiries for all states outside of primary area and processing claims and adjustments submitted by host providers within primary area.

The incumbent maintains accurate and timely inquiry and claim resolution to ensure acceptable call center service levels, claims timeliness and quality, and all client performance guarantee measures are achieved. This job is client facing and directs ongoing collaboration meetings with internal sales teams and with the assigned clients. Complete administrative tasks such as, performance reviews, time and attendance, training requests, system access, move requests, and employee corrective actions as appropriate.

Provide assistance and guidance to staff on more complex issues and handle all escalated issues to promote Customer First behavior and to resolve in a timely and accurate manner. Lead claim clean-up projects and ensures timely and accurate completion of all work and assists with the development of the client communication and response.

Also the key point of contact for third party audits for assigned clients. Ensure all operational processes are in compliance with established quality standards, compliance regulations, and client requirements. Supervisor Member Services.

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Highmark bank rapid city sd Ensure that all staff achieves the minimal qualification of their position through ongoing staff development, counsel and motivate employees, evaluate employees, investigate complaints highmark supervisor benefits performance concerns; implement disciplinary action as needed and in consultation with appropriate authority and Employee Relations. Ability to clearly articulate processes and procedures to all staff and management click the following article. Look for opportunities to improve such processes. Senior Level. Disclaimer: The job description has been designed to indicate the general nature and carefirst edi duties and responsibilities of work performed by employees within this job title.
Emblemhealth ronkonkoma Manages areas which may include authorizing higymark admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Supervisor Member Services. Implement integration processes and planning activities. Accountable for special projects and enhanced activities within the department. Supervisor Job in Harrisburg, PA.
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Highmark supervisor benefits Role model to staff and assist in the day to day activities as needed. Subject matter expert for benefit plan and claims processing. It conduent corp not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. This includes but benedits not limited benefitx adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Introduce click at this page and we'll get in touch monthly to share career insights and company news. Ability to clearly articulate processes and procedures to all staff and management personnel. This website uses cookies.
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Blue carefirst cross maryland Implement integration processes and planning activities. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Represent the department in compliance audits as it relates to the supervisor functions. Highmarm includes utilization management, strategic planning, care cost initiatives, system development and quality outcomes. Look for opportunities to improve such processes. Supervisor Enhanced Community Care Management.
Centene accountant salary May also manage appeals for services denied. Handles and responds to inquiries for all states outside of primary area and processing claims and adjustments submitted by host providers within primary area. Covid Vaccination Information Effective November 1,Highmark Health and its affiliates are requiring all new hires beginning employment to submit supervvisor of full vaccination with one of the three authorized COVID vaccines. Ability to communicate well in person, via phone and via e-mail verbally and written. Highmark Health. Create a check this out environment that recognizes rewards and motivates employees to continuously improve business processes to spuervisor greater value to click here products and programs supplied to our members. Supervisor Utilization Management.

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The many benefits that come with Highmark plans - Member

Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of . You are entitled to receive a Summary of Benefits and Coverage (SBC). The SBC makes it easier for you to understand your health care benefits, find out what's covered, and compare . Dec 12, аи This information is issued on behalf of Highmark Wholecare, coverage by Gateway Health Plan, which is an independent licensee of the Blue Cross Blue Shield .