- TEKsystems (Menasha, WI)
- Member Experience Representative - Healthcare Customer Service Remote (First 90 Days) → Hybrid in Brookfield or Menasha, WI Are you passionate about helping others ... you thrive in a fast-paced, service-driven environment? What You'll Do As a Member Experience Representative, you'll be the first point of contact for members,… more
- Molina Healthcare (Green Bay, WI)
- …and IRE experience** **Job Summary** Responsible for reviewing and resolving member appeals and communicating resolution to members and provider (or authorized ... and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution… more
- Molina Healthcare (Green Bay, WI)
- …Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider complaints and communicating resolution to members or authorized ... and requirements established by the Centers for Medicare and Medicaid . **Knowledge/Skills/Abilities** + Responsible for the comprehensive research and resolution… more
- Molina Healthcare (Green Bay, WI)
- …objectives. Manage for all Medicare lines of business the annual Medicare and Medicare- Medicaid Plan Applications and Plan Benefit Package design, as well as provide ... file) + BRD development/Multiple third-party applications that contain Molina member data (examples, case management, MTM). **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Green Bay, WI)
- …fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay ... legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid , Tricare, Pharmacy, etc.) + Experience with UNET, Comet, Macess/CSP,… more
- Grifols Shared Services North America, Inc (Green Bay, WI)
- …territory including major accounts and large players (ie, Commercial, Medicare, and Medicaid ) *Understanding of Hospital formulary with guidance of RSD and NAM/NAD ... needs and impact pull-through (eg, MSL, IG Nurse Educator, reimbursement specialist ) *Gather and provide customer insights to Marketing teams for development… more
- Somatus (Green Bay, WI)
- …care team meetings. + Act as the patient advocate and support the member through their patient journey starting with initial outreach. + Conduct telephonic outreach ... on a monthly basis Qualifications Required + Experience working with Medicare, Medicaid or Special Needs populations. + Medical Assistant, Licensed Practical Nurse,… more