Prepare accurate and timely financial statements in compliance with GAAP and Statutory Accounting Principles. File Statutory statements with the National Association of Insurance Commissioners (NAIC), New York Department of Financial Services (DFS), Department of Health (DOH), and Center for Medicare and Medicaid Services (CMS). Prepare audited financial statements includ

Collaborate with the Director and other departmental leaders in managing the budgeting and forecasting process. Act as key point person for managing the allocation of administrative expenses across the P&L. Serve as a key participant in the operating expense monthly variance meetings, annual planning, and recurring forecasting processes. Partner with business areas to ana

Prepare journal entries, account reconciliations and other analyses as part of the month end close process. Ensure that the monthly close for EmblemHealth is performed timely, accurately and in accordance with Generally Accepted Accounting Principles (GAAP). Participate in the development and enhancement of internal controls over financial reporting and process improvemen

of Position We are seeking a talented Grievance & Appeals Specialist who will be responsible for responding to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, State, and other regulations. They will process appeals and grievances to facilitate the accurate administration of benefits and clinical

Make an Impact! Provide general nursing care to patients as well as care coordination in collaboration with other members of the care team. Ensure practices of the care team are in accordance with nursing standards local, state, and federal guidelines, and organizational policy. Develop and Enhance your Leadership Skills! Provide clinical supervision to Licensed Practical

of Position The Care Team Associate II serves as a member of the Care Team in the treatment and care of patients who assists providers with clinical services and administrative tasks to support population health guided best in class care. The position works under the supervision of the Practice Administrator and in collaboration with the Nurse Manager. The Care Team Associ

of Position The Care Team Associate II serves as a member of the Care Team in the treatment and care of patients who assists providers with clinical services and administrative tasks to support population health guided best in class care. The position works under the supervision of the Practice Administrator and in collaboration with the Nurse Manager. The Care Team Associ

Manage the day to day responsibilities of telephone performance, coaching/counseling the customer service team, and inventories of offline work including eCorrespondence, social media, and HIPAA/Privacy form updates. Responsible for systemic testing related to updates to the CRM and the website portal; assist in training initiatives. Drive weekly meetings with call center

Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance. Develop studies, analyses, and presentation materials needed to appropriately inform decision makers. Complete pricing analysis, experience analysis and studies, financial projections, and other actuarial/financial calculations. Run, modify, and create

of Job Manage the day to day sales activities of the Direct to Consumer and Individual markets (Medicaid, Child Health Plus, The Essential Plan and QHP) and implement any strategic or tactical plans. Work closely with the Regional Sales Leader, Government Assisted Program (GAP), Enrollment and Customer Service to ensure high levels of service and responsiveness. Responsibi

of Job Responsible for implementing end to end campaign creation, execution, delivery and measurement, primarily leveraging Salesforce Marketing Cloud email/journeys, Adobe Campaign, Adobe Experience Manager (CMS), and Adobe Analytics. Participate in the creation of SFMC campaign journey/workflow design, to execute email campaign activation and delivery. Develop automated

Deliver operations training programs that encompass a blended approach (instructor led modules, self paced activities, flipped classroom, group activities, videos, and eLearning). Responsible for multiple training topics (Products, Guidelines, polices & procedures, Systems utilized by Ops staff, etc.) Responsibilities Facilitate delivery (in person and virtual) of product

of Position Serve as the key operational liaison with Provider Network Management and Finance responsible for the reconciliation, reprocessing/recoupment and provider communication for claim payment integrity challenges. Oversee contract review; ensure that contract provisions are in alignment with corporate goals. Develop and implement dashboards to monitor performance. D

of Position We are seeking a dynamic Grievance and Appeals Dispute Specialist who will be responsible for processing disputes submitted by contracted and non contracted providers. The types of correspondence handled by the individual will include, but is not limited to; correspondence, HQSI/ESMSEF appeals and Cotiviti disputes. This individual will provide technical and ad

Serves in an account management (non sales) role as the primary business to business liaison between ConnectiCare and its provider network and is responsible for all interactions between the organizations. Continuously educates provider community about ConnectiCare and its policies and procedures. Build and develop partnerships with ConnectiCare's Tier I and Tier II provi