Coordinates with marketing team members and various vendors/departments to help develop communication plans and related communications materials. Assists with various tasks required for the marketing department. Conducts formatting, peer reviews and quality checks to ensure material and content accuracy and brand consistency. Analyze data and build reports to improve comm

Triages incoming emails and phone calls from brokers/agents Follows up with brokers/agents on applications, new plan options for current members and late premium payments Assists in the coordination of administrative tasks necessary to provide the highest level of service to our current brokers/agents in support of new enrollments, membership growth and retention of our c

Participate in employee recruitment, selection, orientation, training, evaluation, coaching, development with a focus on quality and compliance Supervise the Agent Advisors in their support of the Sales Executives responsible for daily operation of call center team including scheduling and managing work assignments, assisting on the phone, and monitoring overall team perf

Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality. Reviews claims to ensure compliance with proper billing standards and completeness of information. Obtains additional information from appr

Demonstrates commitment and behaviors aligned with the philosophy, mission, values, and vision of Network Health. Applies organizational, regulatory, and credentialing principles, policies, and procedures to the claims production process. Assists the Manager of Claims Production and/or Manager of Claims Recovery with regulatory reporting and compliance audits, including D

Validation testing of new data sources to existing with reporting identifying variances in written communication User testing of portal functionality and data to existing source system results Correction of any data integrity issues Development of reconciliation exhibits to show balance sheet figures are used consistently across various financial calculations Assist in cr

Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies Employment Law partner with Human Resources to offer trainings and reminders on best practices regarding the FMLA, ADA, etc. Contr

Develops, maintains and regularly reviews department policies, processes and desk procedures to ensure regulatory compliance, maximum efficiencies, and alignment with industry best practice; identifies gaps and works with department leadership and/or trainers to facilitate implementation of improved processes. Daily supervision of staff and department operations Establish

Performs data entry, claim, and call monitoring activities and scores performance according to set criteria and timelines Perform other operational audits and scores performance according to set criteria and timelines. Trends monitoring results and provides feedback to the Manager of Quality Assurance Compiles results into meaningful, actionable reports with recommendatio

Perform end to end delivery of data interfaces in various stages of the Enterprise Data Warehouse in accordance with professional standards and industry best practice Perform all phases of the development lifecycle including solution design, creation of acceptance criteria, implementation, technical documentation, development and execution of test cases, performance monit

Evaluate and process prior authorization requests/referrals submitted from contracted and non contracted providers Follow Network Health process, policies, and procedures in authorization review of all membership on a pre service, concurrent and post service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management

Fully reviews all appeals and grievances assigned, to determine appropriate supporting documentation needed to address the issue being appealed. Compile supporting documentation for appeal process. Resolve any discrepancies in information with internal departments or providers as necessary. Communicate with members regarding status of appeals that have been submitted. Per

Develop, update and coordinate work associated with the operational annual product refresh and benefit implementation. Collaborate with various departments on deliverables to ensure they are submitted timely and accurately to avoid financial penalties. Act as a liaison between product development department and numerous business owners from different functional areas of t

Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies Process enrollment applications, changes and terminations for all products received. Responsible for handling incoming and outgoin

Demonstrate commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health Appropriately apply all organizational and regulatory principles, procedures, requirements, regulations, and policies Performs data entry, claim, and enrollment monitoring activities and scores performance according to set criteria and timelines. Compiles results