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Configuration Analyst II
WellSense Health Plan
-
Boston, MA
The Configuration Analyst II is a key contributor that is responsible for configuring and maintaining the Cognizant/Trizetto Facets system. This position demands a unique blend of critical thinking, technical proficiency and communication skills to support the business needs. Our Investment in You Full time remote work Competitive salaries Excellent benefits Key Functions
Email Job
Posted Today
Licensed Behavioral Health Clinician
WellSense Health Plan
-
Manchester, NH
The Licensed Behavioral Health Clinician provides care management services at facilities, in the community and telephonically for WellSense members receiving behavioral health (BH) and substance use services. The Licensed Behavioral Health Clinician works alongside medical Utilization Management and medical Care Management staff, pharmacists, and medical directors as part
Email Job
Posted Today
Senior IT Project Manager
WellSense Health Plan
-
Boston, MA
Responsible for the coordinated management of multiple large scale, critical or complex projects. The Senior IT Project Manager (PM) is responsible for overseeing all aspects of project work to ensure that goals and objectives are accomplished within the constraints of the budget, schedule, and stakeholder expectations. Monitors progress according to plan, identifying and
Email Job
Posted 1 day ago
Manager of Healthcare Analytics
WellSense Health Plan
-
Boston, MA
The Manager of Healthcare Analytics is responsible for financial analysis, measurement, and contract compliance as it relates to WellSense's Clinical Vendors. Working closely with Finance leadership, clinical leadership, and leaders from WellSense's Clinical Vendors, the Manager will ensure the financial integrity of these partnerships by leading the development and commu
Email Job
Posted 1 day ago
Manager Clinical Audit
WellSense Health Plan
-
Boston, MA
The Manager Clinical Audit provides oversight and leadership of the Clinical Audit Team within the Payment Integrity Department. The Clinical Audit team performs detailed medical record and chart audit review of the health plan's claims to ensure that all reimbursement to the provider is paid accurately. The Clinical Auditors are a liaison and resource between the health
Email Job
Posted 1 day ago
Encounter Operations Analyst (Healthcare)
WellSense Health Plan
-
Boston, MA
It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25 year history of providing health insurance that works for our members, no matter their circumstances. ESSENTIAL RESPONSIBILITIES / DUTIES Serve as the lead in managing operational aspects of WellSense's encounter data process; including the reporting and tracking
Email Job
Posted 1 day ago
Consumer Insights Analyst
WellSense Health Plan
-
Boston, MA
The Consumer Insights Analyst supports the Health Plans efforts to gain a deeper understanding of how our targeted populations, prospects and members think and feel about our brand, products and services. This position will work closely with the internal and external resources tasked with providing information in support of improving quality surveys, brand scores, member
Email Job
Posted 1 day ago
Business Process Engineer
WellSense Health Plan
-
Charlestown, MA
The Business Process Engineer will bring Lean and Six Sigma process engineering principles to design and/or optimize business processes and improve their overall performance. This position partners extensively with cross functional teams and leadership, in the application of process engineering principles to design and/or optimize business processes and their overall perf
Email Job
Posted 1 day ago
Behavioral Health Program Manager
WellSense Health Plan
-
Boston, MA
At the direction of the Manager of Behavioral Health Operations, the Behavioral Health (BH) Program Manager, New Hampshire (NH) is responsible for leading and resolving high visibility behavioral health (BH) initiatives, issues and priorities through significant interface with the health plan's material subcontractor. Key deliverables include the oversight of New Hampshir
Email Job
Posted 1 day ago
Accounting Clerk
WellSense Health Plan
-
Boston, MA
The Accounting Clerk will provide accounting and clerical support to the accounting department under Accounting Manager's supervisions. This position handles check deposits and returned checks, coordinates with various departments to update check status in claims processing system. Also, to complete assigned jobs professionally and diligently with strong computer skills a
Email Job
Posted 1 day ago
Regulatory and Transaction Coding Manager
WellSense Health Plan
-
Boston, MA
Develops and maintains corporate transaction policies, and works collaboratively with stakeholders and department manager to ensure consistency with the Plan's system(s) Monitors sites and regulation governing healthcare transaction data to include AMA, CMS, NUBC, UB Editor, WPC DHHS, EOHHS, and, listservs and other sources to identify existing coding & payment practice a
Email Job
Posted 1 day ago
Consumer Data Analyst
WellSense Health Plan
-
Boston, MA
The Consumer Data Analyst is a key role in our Consumer Insights area, which drives our understanding of prospect and member behavior, allowing us to develop strategies and tactics to grow our business. This position will support the analysis and reporting of campaign data to determine the best strategies and tactics to acquire and retain members. Working with marketing,
Email Job
Posted 1 day ago
Provider Relations Consultant (Boston/Northeast MA) - $5000 sign on bonus!
WellSense Health Plan
-
Boston, MA
Investigate, document, track and assist with claims resolution Interact with various operational departments to assure accurate and timely payment of claims in accordance with WellSense policies and procedures Identify system changes impacting claims processing and work internally on resolution Identify systematic issues and trends and research for potential configuration
Email Job
Posted 1 day ago
Pharmacy Quality Coordinator
WellSense Health Plan
-
Boston, MA
Responsible for documenting and data entry of program activities, member information, notifications, or other administrative materials within the appropriate clinical management systems or reports; may require completion of questionnaires or surveys Coordinate prior authorization needs with the PBM and/or the Pharmacy Services team to improve gaps in medication management
Email Job
Posted 6 days ago
Instructional Designer - Diversity, Equity, & Inclusion
WellSense Health Plan
-
Boston, MA
The Instructional Designer creates, develops, and updates training courses and materials for the Operations Department of WellSense Health Plan. This individual works closely with business partners, subject matter experts, and key stakeholders to develop engaging and effective learning for our Diversity, Equity, & Inclusion program. This position is ideal for someone with
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Posted 6 days ago
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