CommUnityCare Jobs

JOB SUMMARY. This position is responsible for maintaining the entry and maintenance of the customer database. Maintains customer files and data according to regulations. KEY RESPONSIBILITIES. Generates customer correspondence and distributes information. Creates and maintains customer eligibility in the database. Reviews information to determine requirements. Reviews and processes enrollment information to ensure compliance with all regulations. ...

JOB SUMMARY. The Complex Claims Specialist is responsible for examining claims that require review prior to being adjudicated. Claims are generally of the largest dollar value and require extreme attention to detail and strong knowledge of claims processing. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. The Complex Claims Specialist will generally...

JOB SUMMARY. The Customer Service Supervisor will build a strong team of Customer Service Representatives and shape staff behaviors to accomplish desired results to meet the expectations and needs of our members, providers and internal customers. You will be responsible for providing ongoing coaching to inspire our Customer Service Representatives to deliver exceptional customer service as well as coaching to develop CSRs in their current role or...

JOB SUMMARY. Responsible for processing reports, reconciling transactions and updating the system. Create and maintain customer eligibility in the company database, generate customer correspondence for new packets, assemble and distribute customer handbooks and process notifications. . KEY RESPONSIBILITIES. Create and maintain customer eligibility in the database. Generate appropriate correspondence and ID cards. Review and process files and repo...

JOB SUMMARY. Responsible for completing out-bound calls and other member outreach opportunities to select members and documenting efforts. This role spends 100% of time on quality program activities.  May require extended, or multiple, phone calls to members.  May require work on additional projects as directed. . KEY RESPONSIBILITIES. Contact members selected for intervention. Assist members with developing a plan to resolve identified HEDIS gap...

JOB SUMMARY. This position is a part of a team that provides support to our sales and retention reps in the form of data gathering, data entry and analysis, proposal and financial exhibit development, and coordinates with internal and external customers to install and renew employer group benefits. . KEY RESPONSIBILITIES. Monitor email and respond to Request for Proposals (RFPs):  Gather benefit information from a variety of sources, coordinates ...

JOB SUMMARY. Responsible for selling Medicare products and Individual Health Plan products via telemarketing calls and person-to-person meetings, including seminars. . KEY RESPONSIBILITIES. Discuss products and benefits with eligible beneficiaries on a person to person basis in various settings. Makes outbound calls, as allowed, to prospects to answer questions and to schedule further sales follow up calls. Receives inbound calls from prospective...

JOB SUMMARY. This position is a part of a team that provides support to our sales and retention reps in the form of data gathering, data entry and analysis, proposal and financial exhibit development, and coordinates with internal and external customers to install and renew employer group benefits. . KEY RESPONSIBILITIES. Monitor email and respond to Request for Proposals (RFPs):  Gather benefit information from a variety of sources, coordinates ...

JOB SUMMARY. This position is a part of a team that provides support to our sales and retention reps in the form of data gathering, data entry and analysis, proposal and financial exhibit development, and coordinates with internal and external customers to install and renew employer group benefits. . KEY RESPONSIBILITIES. Monitor email and respond to Request for Proposals (RFPs):  Gather benefit information from a variety of sources, coordinates ...

JOB SUMMARY. The pharmacy intern will provide support to the CommunityCare Pharmacy Department by participating in Medicare Stars, Medication Adherence, and Medication Therapy Management Programs. This position will also provide clinical support for Pharmacy & Therapeutics, Prior Authorizations, and other clinical reviews and research as needed. Effective communication is an important part of this role. The position will be interacting with membe...

JOB SUMMARY. Responsible for the review, analysis, reporting and follow-up of risk adjustment and clinical coding functions to support the accurate representation of the member's clinical health status as well as the accuracy of internal systems to support clinical decisions. This role works collaboratively with multiple internal departments as well as with external providers. KEY RESPONSIBILITIES. Serve as clinical coding resource across the Com...

JOB SUMMARY. Provide enterprise-wide system infrastructure support for effective installation/configuration, operation, and maintenance of systems hardware and software. This individual participates in technical research and development to enable continuing innovation within the infrastructure, as well as ensuring that system hardware, operating systems, software systems, and related procedures adhere to organizational values. This individual will ...