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Manage efforts to implement and revise correspondence, resulting from operation activity forutilization management, claims, and complaints/grievance/appeals, to ensure accurate content within the templates and the templates are implemented or revised within the timelines required. Completion of the client requirement document (CRD) to accurately reflect contract and regulatoryrequirements. Present
Posted 1 day ago
Under the direction of the Director of Technical Services and Engineering, the successful candidate Manage production and pre production technology systems in a hybrid cloud/datacenter environment Automate building systems and deploying applications. Create additional automation by scripting repetitive tasks Manage and support Active Directory (Directory Services, DFS, DNS, GPO) Coordinate with th
Posted 1 day ago
Primary responsibilities include assisting with all Claims Operations, Network Development, and Customer Service for DentaQuest's vision business. This position is critical to establishing and maintaining all functions within the vision business unit under the direction of DentaQuest's Vision Director. JOB RESPONSIBILITIES Network Development activities in new and existing markets Recruit non part
Posted 1 day ago
Compliance and Policy/Process Review Research and review federal and state regulations to determine the applicability to operations. Coordinate with Legal and Compliance, as necessary. Assist with the development of policies and procedures for operations, as well as the annual policy review. Work collaboratively with a technical writer to draft and review of RFP responses on behalf of operations,
Posted 1 day ago
Manage efforts relating external audits for complaints/grievances/appeal to carry forth quality audit documentation in a timely fashion. This to include Completion of audit tools provided by the auditing entity Compile audit universe, based on instruction received from the auditing entity Complete data validation of the audit universe content Conduct WebEx demonstrations to the auditing entity of
Posted 1 day ago
Demonstrates understanding of DQ's goals and objectives and customer business needs by using IT methodologies to ensure appropriate solutions are implemented. Develops high level architecture design documents to facilitate integration of in house development project and/or vendor based application within the existing enterprise architecture. Develops/Maintains "Best Practices" policies/procedures
Posted 1 day ago
Demonstrates understanding of DQ's goals and objectives and customer business needs by using IT methodologies to ensure appropriate solutions are implemented. Develops high level architecture design documents to facilitate integration of in house development project and/or vendor based application within the existing enterprise architecture. Develops/Maintains "Best Practices" policies/procedures
Posted 1 day ago
DentaQuest
- Milwaukee, WI
If you are a .NET Developer that has a few years' experience looking for that next job to give you more and if .NET/SQL is your passion our company is for you! We are looking to build out our Agile teams with some enthusiastic developers that have values and passion for quality and the desire to help us get to the next level. You will be working with Microsoft .NET and SQL technologies in some of
Posted 1 day ago
Ensure department is meeting client expectations and terms of contract requirements consistently across all functions and locations. Develop and maintain staff speed and accuracy measurements for the Intake & Digital Services group enterprise wide to ensure all client contractual and compliant requirements are met as well as department production standards. Ensure departmental goals are met by mai
Posted 1 day ago
Analyzes and evaluates business requirements by working with clients and management. Provides recommendations on the nature, scope and complexity of solutions Acts as Lead by developing and documenting functional and technical specifications and project plans for proposed solutions to business requirements of moderate to high complexity. Develops (codes), tests, documents, educates and supports su
Posted 1 day ago
Directly manage and provide leadership for the Care Delivery IT team, overseeing day to day delivery and engaging in routine and escalated service issues Stays abreast of trends and advances in IT solutions. Presents business cases to Senior Management to win acceptance and secure agreement to proceed. Co develop with the SVP of Technology and support of the Care Delivery IT plan in alignment with
Posted 1 day ago
Electronic Enrollment Quality Analysts support IT goals and objectives by working closely with other analysts to ensure that changes to DentaQuest's enrollment processing systems are meeting business requirements and processing membership information correctly. Electronic Enrollment Quality Analysts work closely with Software Developers and Business Analysts to review use cases and develop and exe
Posted 1 day ago
Enter and maintain Provider applications, contracts and updates into the system. Enter and maintain all Provider information into credentialing database. Verify potential and existing Provider's license, liability insurance, BNDD, CDS and DEA certificate. Verify Provider's education, hospital privileges, Board certification and other criteria as required. Verify accurate banking & billing informat
Posted 1 day ago
The Performance Test Engineer will support operational goals and objectives by working closely with software developers, software quality assurance team members and business stakeholders to review use cases and develop and execute test plans, and test cases to ensure application development meets or exceeds business requirements. The Performance Test Engineer will support operational goals and obj
Posted 1 day ago
Independently interpret utilization reports to detect patterns and potential areas of fraud, waste or abuse. Query data to conduct comprehensive drill down data analysis to detect patterns and trends of under and over utilization. Investigate provider and member fraud and abuse in assigned markets. Manage multiple clients and associated provider networks related to fraud, waste and abuse investiga
Posted 1 day ago
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