- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …to blue. Reporting to the SVP, Sales & Client Management, the Director, Group Medicare Sales, is an integral member of the leadership team-driving BCBSMA's ... purposeful re-entry into the Group Medicare Advantage Market . The role will have...and Chief Actuary; SVP, Underwriting; EVP, Sales, Marketing & Service ; SVP of Sales and Account Service ,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and Management, Performance Measurement and Improvement, Health and Medical Management, and Medicare Markets . This role is eligible for our Flex persona. ... us transform healthcare? Bring your true colors to blue. What We Need The Medicare Advantage Network Performance Manager, as a member of a cross-functional team,… more
- Humana (Boston, MA)
- …how organization capabilities interrelate across the function or segment. The Director, Group Medicare Mid- Market Sales & Labor Relations leads a team that sells ... our Sales associates to drive consistent growth for the Mid- Market segment. This role requires an in-depth understanding of...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …a team of professionals, including clinical utilization managers, account representatives, member service associates, dietitians, and physicians, to provide ... to facilitate care. Key Responsibilities: + Continually assess and evaluate member and family needs utilizing strong communication skills, critical thinking,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …of and/or influence of product, marketing, sales, and operations business plans + Lead Medicare Integrated Medicare Market Team (IMMT) to support the ... Market Research, Sales, Operations, and Compliance + Oversee Medicare Market project management resources and ensure...yield results. + Develops innovative strategies to support the Medicare Markets business plan and product growth… more
- Commonwealth Care Alliance (Boston, MA)
- …Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, ... to the Health Plan Chief Medical Officer (CMO), the Massachusetts and Rhode Island Market Medical Director is an integral part of a mission-driven clinical and … more
- Commonwealth Care Alliance (Boston, MA)
- … and provider contact centers and member communications functions across all markets and products. The VP for Customer Service and Consumer Experience ... members and providers. Supervision Exercised: Yes. Direct Reports Include the Director of Member Service , Director of Provider Service , Senior Director of… more
- Humana (Boston, MA)
- …conducts Utilization Management of the care received by members in an assigned market , member population, or condition type. May also engage in grievance ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large.… more
- Humana (Boston, MA)
- …conducts Utilization Management of the care received by members in an assigned market , member population, or condition type. May also engage in grievance ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large.… more
- Humana (Boston, MA)
- …conducts Utilization Management of the care received by members in an assigned market , member population, or condition type. May also engage in grievance ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large.… more
- Humana (Boston, MA)
- …conducts Utilization Management of the care received by members in an assigned market , member population, or condition type. May also engage in grievance ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large.… more
- WellSense (Boston, MA)
- …health insurance company serving members across Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25 years ago as ... responsibleand accountablefortheoverallstrategicdirectionoversight,analysis,clinical compliance anddatareportingfor all products and in all markets . The Senior Director ensures that the delivery of… more
- Prime Therapeutics (Boston, MA)
- …and enhance member experience in alignment with the Centers for Medicare & Medicaid Services (CMS) program requirements. + Develop quality specific data needs ... and processes that drive Star ratings and measurable results. + Develop a comprehensive Medicare Star Ratings and CAHPS strategy that meets the needs of clients to… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Must be able to develop a proficient understanding of CCA's products and the Medicare market + Must be able to develop a proficient understanding of CCA's ... various regulations, and skill in managing processes for multiple markets . The individual in this role will be expected...considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex,… more
- Humana (Boston, MA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... of action. **Key Responsibilities:** + Generate reports and deliver them to the markets + Ability to become a SME in various reporting platforms (ex. Availity,… more
- Commonwealth Care Alliance (Boston, MA)
- …Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, ... Exercised:** None **What You'll Be Doing:** + Knowledge of Medicare Star Rating methodology; NCQA HEDIS measures; CAHPS and...that is easily understood and actionable by key stakeholders ( Market , Quality, Pharmacy, Member experience team) in… more
- Commonwealth Care Alliance (Boston, MA)
- …Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, ... state health care law requirements applicable to CCA, including Medicare and Medicaid rules, HIPAA privacy and security, healthcare...in responding to RFPs and pursuing growth in additional markets . + Assures compliance with all relevant laws and… more
- Humana (Boston, MA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... Strategy Advancement Advisor enhances operational stability and effectiveness for market -based processes that support Provider Engagement, Quality/Stars, Interoperability, and… more
- Elevance Health (Hingham, MA)
- …MA, Harrisburg PA or Syracuse NY._ **National Government Services** is a proud member of Elevance Health's family of brands. We administer government contracts for ... Medicare and partner with the Centers for ...routine nature. Responsible for maintaining compliance activity, exceptional customer service and data processing and balancing. **How you will… more
- Elevance Health (Newton, MA)
- …are or should be enrolled in other coverage. + Aides members in enrolling in Medicare when they are entitled. + Determines primacy on each case using a complex set ... Primacy and NAIC rules and comparing them against the member /group's benefits. + Updates all of the company's membership...correct forms are provided to assist members enrolling in Medicare . + Reviews claim history to identify claims requiring… more