Additional Information. Organization: HAP (Health Alliance Plan). Department: Vendor Operations Mgmt. Henry Ford Health Location: HAP (Health Alliance Plan). Shift: Day Job. Union Code: Not Applicable.
GENERAL SUMMARY. Responsible for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Commercial, Medicare Advantage, Medicare-Medicaid Program (MMP), and Medicaid lines of business. Identify trending issues on an ongoing basis and provide root/cause analysis when required. The Analyst will work with HAP’s medical directors, nurses, pharmacists, Legal department, and other subject matter experts to deter...
GENERAL SUMMARY. Responsible for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Commercial, Medicare Advantage, Medicare-Medicaid Program (MMP), and Medicaid lines of business. Identify trending issues on an ongoing basis and provide root/cause analysis when required. The Analyst will work with HAP’s medical directors, nurses, pharmacists, Legal department, and other subject matter experts to deter...
General Summary. To ensure all incoming claims/documents are distributed and routed accurately to the appropriate departments. Utilizing Pega and Facet systems to increase the efficiency of the Claim and Enrollment departments by providing support for the Claims Processors, Enrollment Reps., Adjustment Reps., and COB Analysts. Coordinate and participate in departmental activities to increase efficiency and process layout. Principal Duties And Res...
Primary Objectives. To supervise, organize and coordinate the HMO, Medicare Advantage and Federal Government call center operations associated with HAP's Customer Service Department, which includes lobby, written/electronic correspondences, and clerical operations. To maximize service levels through scheduling, floor management activities, coaching employees and managing performance for service excellence. To maintain and report on all informatio...
General Summary. Coordinate processing and maintenance of provider contracts and maintenance of provider demographic information including new contracts, terminations and modifications, and configuration of Contract Manager, Facets or its successor systems. As a team member, provide administrative support, coordinate, and prepare appropriate correspondence/contracts/audits for regulatory agencies, network maintenance projects, and strategic initi...
General Summary. The Office Services Specialist provides comprehensive onsite support for mailroom, print center, marketing logistics, and general office service operations. This role ensures accurate, timely, and secure handling of mail, packages, and print requests for all departments, while maintaining office equipment, managing supplies, assisting with conference room set up and AV support, and supporting offsite marketing events. The positio...
General Summary. This position has the following primary objectives with respect to customer relations for all HAP product lines: (1) Provide follow-up and courteous and prompt resolution to internal and external customer inquiries by conducting thorough investigations and fully educating customers. (2) Support corporate and departmental goals, member enrollment activities and product implementations. (3) Research, investigate and resolve service...
General Summary. Responsible for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan’s (HAP’s): Commercial, Medicare Advantage, Medicare-Medicaid Program (MMP), and Medicaid lines of business. Analyst must identify trending issues on an ongoing basis and provide root/cause analysis when required. The Analyst will work with HAP’s medical directors, nurses, pharmacists, Legal departme...
General Summary. Responsible for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan’s (HAP’s): Commercial, Medicare Advantage, Medicare-Medicaid Program (MMP), and Medicaid lines of business. Analyst must identify trending issues on an ongoing basis and provide root/cause analysis when required. The Analyst will work with HAP’s medical directors, nurses, pharmacists, Legal departme...
