Job Summary: Support contract performance management of a large health system. Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines. Identify and analyze single issues and trends to determine root causes...

SummaryLead provider innovation, initiatives and network strategies including network provider pricing/fee schedules, cost optimization, trend analysis, Provider Network improvement opportunities, value-based contracting, provider incentive programs and other strategies while continuously improving ...

Summary of PositionAct as a liaison and operates as a vital link between specific Facility, Ancillary, Delegated and/or Professional providers and EmblemHealth. Responsible for day to day operations for all activities related to contracts with minimal supervision and direction, contract optimization...

Summary of Position Provide statistical analysis of pharmacy-related data, functioning as a partner to actuarial, finance medical economics, medical management and network for well-informed decision-making. Produce creative and insightful approaches to information analysis and management, allowing l...

Summary of Position Responsible for the development, support, and production of external communications that inform, engage, and meet regulatory requirements.Principal AccountabilitiesProject Management/Production Collaborate with internal customers to develop strategic communications that meet both...

Summary of Position Manage a team of financial analysts to meet the key initiatives of the company: provide timely, accurate, actionable data and analysis supporting the department, area, and corporate key initiatives. Develop initiatives to increase profitability and decrease medical expenses. Deve...

Summary of Position Provide guidance to a team of financial analysts who provide timely, accurate, actionable data and analysis supporting the department, area, and corporate key initiatives. Manage financial analysts to meet the key initiatives of the company. Develop initiatives to increase profit...

Summary of Position 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 studie...

Summary of Position Develop/design and test policies for review and approval by Actuarial Management and present statistical information to actuarial, underwriting, and other business partner leaders to support decisions about the pricing of plans, product development and marketing planning. Adminis...

Summary of Position Support the marketing department/teams to advance the effectiveness of our web properties and contribute to the growth and capabilities of our digital team. Collaborate with our partners to determine digital objectives and develop applications that align those goals and support o...

Summary Proofread and edit documents for EmblemHealth, ConnectiCare, AdvantageCare Physicians, and other entities within the family of companies, as needed. Review print and digital projects to ensure clear and consistent messaging that is error-free, grammatically correct, and consistent with the e...

Summary of Position Develop and communicate analytical reports and dashboards on various company initiatives. Provide data insights on current campaigns or web pages and use previous data to predict the performance of new initiatives. Assist and evaluate search engine marketing and search engine opt...

Summary of Position Promote quality achievement and performance improvement throughout the organization. Frequently interface with and direct quality management counterparts or vendors to continuously improve performance for claims, customer service, provider service, enrollment and billing, and med...

Summary of Position Lead an Enterprise-wide cross-functional team of Operations trainers who are responsible for developing and facilitating courses designed to support new hire classes/ongoing refresher training to the Call Centers and other areas under Ops. Lead the instructional design of program...

Summary of Position Collaborate with the Director to develop and provide training and education programs that include onboarding of new non- clinical G&A employees and continuing education for all non-clinical G&A staff. Develop and maintain reference and resource materials. Assist with creation and...