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Showing 801 Anthem Blue Cross jobs in the United States
Healthcare Insurance Authorization Supervisor
66625 Topeka, Kansas
CenterWell
Posted 2 days ago
Job Viewed
Job Description
**Become a part of our caring community and help us put health first**
**Shift/Availability Requirements:**
+ **Monday - Friday**
+ **Available between the hours of** **7am - 7pm EST**
As the **Authorization Supervisor** , you will:
+ Supervise daily authorization activities to ensure maximum efficiency. Provide guidance and direction to staff, covering all aspects of authorization standards/procedures, ensure adherence to policies and procedures, and initiate correspondence to insurance companies.
+ Supervise authorization management functions and maintain assigned portfolios at acceptable levels.
+ Provide guidance and assistance to management at branches assigned on authorization issues.
+ Develop and implement plans to ensure authorization are within stated objectives.
+ Supervise the maintenance of the provider manuals, patient information updates, and various logs.
+ Ensure that authorizations are within the established time frames and that customer service guidelines/guarantees are adhered to. Keep abreast of authorization regulations/requirements, and communicate changes to all pertinent personnel.
**Use your skills to make an impact**
**Required Skills:**
+ High School Diploma or the equivalent.
+ A minimum of three years healthcare related authorization experience.
+ Some experience in a lead or supervisory role generally required.
+ Strong knowledge of collection and accounts receivables procedures preferred.
+ Effective communication skills.
**To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:**
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:**
+ Health benefits effective day 1
+ Paid time off, holidays, and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options
**Shift/Availability Requirements:**
+ **Monday - Friday**
+ **Available between the hours of** **7am - 7pm EST**
As the **Authorization Supervisor** , you will:
+ Supervise daily authorization activities to ensure maximum efficiency. Provide guidance and direction to staff, covering all aspects of authorization standards/procedures, ensure adherence to policies and procedures, and initiate correspondence to insurance companies.
+ Supervise authorization management functions and maintain assigned portfolios at acceptable levels.
+ Provide guidance and assistance to management at branches assigned on authorization issues.
+ Develop and implement plans to ensure authorization are within stated objectives.
+ Supervise the maintenance of the provider manuals, patient information updates, and various logs.
+ Ensure that authorizations are within the established time frames and that customer service guidelines/guarantees are adhered to. Keep abreast of authorization regulations/requirements, and communicate changes to all pertinent personnel.
**Use your skills to make an impact**
**Required Skills:**
+ High School Diploma or the equivalent.
+ A minimum of three years healthcare related authorization experience.
+ Some experience in a lead or supervisory role generally required.
+ Strong knowledge of collection and accounts receivables procedures preferred.
+ Effective communication skills.
**To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:**
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:**
+ Health benefits effective day 1
+ Paid time off, holidays, and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options
Is this job a match or a miss?
View Now
0
Healthcare Insurance Authorization Supervisor
30309 Midtown Atlanta, Georgia
CenterWell
Posted 2 days ago
Job Viewed
Job Description
**Become a part of our caring community and help us put health first**
**Shift/Availability Requirements:**
+ **Monday - Friday**
+ **Available between the hours of** **7am - 7pm EST**
As the **Authorization Supervisor** , you will:
+ Supervise daily authorization activities to ensure maximum efficiency. Provide guidance and direction to staff, covering all aspects of authorization standards/procedures, ensure adherence to policies and procedures, and initiate correspondence to insurance companies.
+ Supervise authorization management functions and maintain assigned portfolios at acceptable levels.
+ Provide guidance and assistance to management at branches assigned on authorization issues.
+ Develop and implement plans to ensure authorization are within stated objectives.
+ Supervise the maintenance of the provider manuals, patient information updates, and various logs.
+ Ensure that authorizations are within the established time frames and that customer service guidelines/guarantees are adhered to. Keep abreast of authorization regulations/requirements, and communicate changes to all pertinent personnel.
**Use your skills to make an impact**
**Required Skills:**
+ High School Diploma or the equivalent.
+ A minimum of three years healthcare related authorization experience.
+ Some experience in a lead or supervisory role generally required.
+ Strong knowledge of collection and accounts receivables procedures preferred.
+ Effective communication skills.
**To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:**
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:**
+ Health benefits effective day 1
+ Paid time off, holidays, and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options
**Shift/Availability Requirements:**
+ **Monday - Friday**
+ **Available between the hours of** **7am - 7pm EST**
As the **Authorization Supervisor** , you will:
+ Supervise daily authorization activities to ensure maximum efficiency. Provide guidance and direction to staff, covering all aspects of authorization standards/procedures, ensure adherence to policies and procedures, and initiate correspondence to insurance companies.
+ Supervise authorization management functions and maintain assigned portfolios at acceptable levels.
+ Provide guidance and assistance to management at branches assigned on authorization issues.
+ Develop and implement plans to ensure authorization are within stated objectives.
+ Supervise the maintenance of the provider manuals, patient information updates, and various logs.
+ Ensure that authorizations are within the established time frames and that customer service guidelines/guarantees are adhered to. Keep abreast of authorization regulations/requirements, and communicate changes to all pertinent personnel.
**Use your skills to make an impact**
**Required Skills:**
+ High School Diploma or the equivalent.
+ A minimum of three years healthcare related authorization experience.
+ Some experience in a lead or supervisory role generally required.
+ Strong knowledge of collection and accounts receivables procedures preferred.
+ Effective communication skills.
**To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:**
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:**
+ Health benefits effective day 1
+ Paid time off, holidays, and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options
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View Now
1
Business Analyst (Healthcare / Insurance)
07932 Florham Park, New Jersey
Robert Half
Posted 3 days ago
Job Viewed
Job Description
Description
A Senior Software Business Analyst is needed to play a crucial role in connecting business requirements to technical solutions. This role involves engaging with stakeholders to gather and analyze requirements, transforming them into actionable functional specifications. Responsibilities include evaluating existing processes, offering solutions to drive business value, and ensuring project success under tight timelines. The position also includes mentoring junior analysts, leading cross-departmental projects, and fostering innovation. Strong analytical and communication skills, along with a solid understanding of software development life cycles, are essential to succeed in this fast-paced environment.
The ideal candidate will work closely with development and QA teams to monitor project milestones, provide updates to stakeholders, and address any project risks and challenges. A proactive approach to improving application usability and efficiency will be critical. Focusing on the specialty pharmacy sector, the organization provides end-to-end solutions including hub services, pharmacy network management, group purchasing (GPO) services, cutting-edge technology platforms, and more. With a strong presence as an industry advocate, the focus remains on delivering strategic channel management, advanced products, and tailored services to optimize patient outcomes and improve healthcare delivery.
** Qualified candidates should have experience with pharmacy insurance, medical insurance, and claims processing **
Key Responsibilities:
+ Collect and translate business requirements into detailed functional specifications for new and existing systems.
+ Perform gap analyses between current system capabilities and business needs using tools like Confluence, flowcharts, and wireframes to document workflows.
+ Create use cases for review during functional testing phases by developers and QA teams.
+ Work with IT teams to evaluate project scope and affected systems, providing strategic insights.
+ Assess new methodologies for feasibility and implementation efficiency.
+ Gain in-depth knowledge of internal software platforms and their underlying functionalities.
+ Analyze and optimize existing processes to identify inefficiencies and propose re-engineering solutions.
+ Host regular meetings with development teams to resolve obstacles and track progress.
+ Provide project status reports to business stakeholders.
+ Identify potential risks and escalate issues as required.
+ Continuously explore opportunities to improve application functionality, making recommendations for enhancements.
+ Maintain compliance with HIPAA regulations and related amendments
Requirements
+ Minimum of 8 years of experience as a Functional or Software Business Analyst.
+ Proven track record of managing multiple projects simultaneously while meeting deadlines and maintaining high-quality performance.
+ Strong communication and interpersonal skills to engage with diverse internal and external stakeholders effectively.
+ Excellent organizational and leadership skills, with the ability to meet tight deadlines without compromising project success.
+ Passion for producing excellent work with meticulous attention to detail and a commitment to accuracy.
+ Ability to think critically, embrace new technologies, and balance stakeholder needs with user requirements.
+ Demonstrated ability to support large-scale IT solutions using modern technologies.
+ Adept in detailed documentation and thoroughly considering technical changes.
+ Strong eye for detail in designing and wireframing UI improvements that enhance user experiences.
+ Experience using SDLC tools, such as JIRA and Confluence.
+ Educational background in Computer Science or related IT fields is a plus.
+ Familiarity with pharmacy operations or healthcare is required.
Technology Doesn't Change the World, People Do.®
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app ( and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use ( .
A Senior Software Business Analyst is needed to play a crucial role in connecting business requirements to technical solutions. This role involves engaging with stakeholders to gather and analyze requirements, transforming them into actionable functional specifications. Responsibilities include evaluating existing processes, offering solutions to drive business value, and ensuring project success under tight timelines. The position also includes mentoring junior analysts, leading cross-departmental projects, and fostering innovation. Strong analytical and communication skills, along with a solid understanding of software development life cycles, are essential to succeed in this fast-paced environment.
The ideal candidate will work closely with development and QA teams to monitor project milestones, provide updates to stakeholders, and address any project risks and challenges. A proactive approach to improving application usability and efficiency will be critical. Focusing on the specialty pharmacy sector, the organization provides end-to-end solutions including hub services, pharmacy network management, group purchasing (GPO) services, cutting-edge technology platforms, and more. With a strong presence as an industry advocate, the focus remains on delivering strategic channel management, advanced products, and tailored services to optimize patient outcomes and improve healthcare delivery.
** Qualified candidates should have experience with pharmacy insurance, medical insurance, and claims processing **
Key Responsibilities:
+ Collect and translate business requirements into detailed functional specifications for new and existing systems.
+ Perform gap analyses between current system capabilities and business needs using tools like Confluence, flowcharts, and wireframes to document workflows.
+ Create use cases for review during functional testing phases by developers and QA teams.
+ Work with IT teams to evaluate project scope and affected systems, providing strategic insights.
+ Assess new methodologies for feasibility and implementation efficiency.
+ Gain in-depth knowledge of internal software platforms and their underlying functionalities.
+ Analyze and optimize existing processes to identify inefficiencies and propose re-engineering solutions.
+ Host regular meetings with development teams to resolve obstacles and track progress.
+ Provide project status reports to business stakeholders.
+ Identify potential risks and escalate issues as required.
+ Continuously explore opportunities to improve application functionality, making recommendations for enhancements.
+ Maintain compliance with HIPAA regulations and related amendments
Requirements
+ Minimum of 8 years of experience as a Functional or Software Business Analyst.
+ Proven track record of managing multiple projects simultaneously while meeting deadlines and maintaining high-quality performance.
+ Strong communication and interpersonal skills to engage with diverse internal and external stakeholders effectively.
+ Excellent organizational and leadership skills, with the ability to meet tight deadlines without compromising project success.
+ Passion for producing excellent work with meticulous attention to detail and a commitment to accuracy.
+ Ability to think critically, embrace new technologies, and balance stakeholder needs with user requirements.
+ Demonstrated ability to support large-scale IT solutions using modern technologies.
+ Adept in detailed documentation and thoroughly considering technical changes.
+ Strong eye for detail in designing and wireframing UI improvements that enhance user experiences.
+ Experience using SDLC tools, such as JIRA and Confluence.
+ Educational background in Computer Science or related IT fields is a plus.
+ Familiarity with pharmacy operations or healthcare is required.
Technology Doesn't Change the World, People Do.®
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app ( and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use ( .
Is this job a match or a miss?
View Now
2
Healthcare Insurance Authorization Supervisor
65108 Jefferson City, Missouri
CenterWell
Posted 3 days ago
Job Viewed
Job Description
**Become a part of our caring community and help us put health first**
**Shift/Availability Requirements:**
+ **Monday - Friday**
+ **Available between the hours of** **7am - 7pm EST**
As the **Authorization Supervisor** , you will:
+ Supervise daily authorization activities to ensure maximum efficiency. Provide guidance and direction to staff, covering all aspects of authorization standards/procedures, ensure adherence to policies and procedures, and initiate correspondence to insurance companies.
+ Supervise authorization management functions and maintain assigned portfolios at acceptable levels.
+ Provide guidance and assistance to management at branches assigned on authorization issues.
+ Develop and implement plans to ensure authorization are within stated objectives.
+ Supervise the maintenance of the provider manuals, patient information updates, and various logs.
+ Ensure that authorizations are within the established time frames and that customer service guidelines/guarantees are adhered to. Keep abreast of authorization regulations/requirements, and communicate changes to all pertinent personnel.
**Use your skills to make an impact**
**Required Skills:**
+ High School Diploma or the equivalent.
+ A minimum of three years healthcare related authorization experience.
+ Some experience in a lead or supervisory role generally required.
+ Strong knowledge of collection and accounts receivables procedures preferred.
+ Effective communication skills.
**To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:**
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:**
+ Health benefits effective day 1
+ Paid time off, holidays, and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options
**Shift/Availability Requirements:**
+ **Monday - Friday**
+ **Available between the hours of** **7am - 7pm EST**
As the **Authorization Supervisor** , you will:
+ Supervise daily authorization activities to ensure maximum efficiency. Provide guidance and direction to staff, covering all aspects of authorization standards/procedures, ensure adherence to policies and procedures, and initiate correspondence to insurance companies.
+ Supervise authorization management functions and maintain assigned portfolios at acceptable levels.
+ Provide guidance and assistance to management at branches assigned on authorization issues.
+ Develop and implement plans to ensure authorization are within stated objectives.
+ Supervise the maintenance of the provider manuals, patient information updates, and various logs.
+ Ensure that authorizations are within the established time frames and that customer service guidelines/guarantees are adhered to. Keep abreast of authorization regulations/requirements, and communicate changes to all pertinent personnel.
**Use your skills to make an impact**
**Required Skills:**
+ High School Diploma or the equivalent.
+ A minimum of three years healthcare related authorization experience.
+ Some experience in a lead or supervisory role generally required.
+ Strong knowledge of collection and accounts receivables procedures preferred.
+ Effective communication skills.
**To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:**
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:**
+ Health benefits effective day 1
+ Paid time off, holidays, and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options
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3
Healthcare Insurance Economics & Analytics Analyst
East Longmeadow, Massachusetts
The MH Group
Posted today
Job Viewed
Job Description
Job Description
Job Description
Location: Remote in US Only
Salary Range: $70,000 – $0,000 annually
Bonus Potential: 3% annually
Industry: Healthcare Insurance
Location: Can be Remote or Office Based
About the Opportunity
Our client, a leader in the healthcare insurance industry, is seeking an experienced Health Economics & Analytics Analyst to join their growing Healthcare Analytics team. This role offers the opportunity to directly influence business outcomes by shaping financial and medical data analysis, developing reporting tools, and providing critical insights that guide leadership decisions.
What You’ll Do
As a Health Economics & Analytics Analyst, you will:
Develop key utilization, financial metrics, and benchmarks to establish baselines and measure cost savings.
Build meaningful dashboards and visualizations using tools such as Tableau or Power BI.
Deliver ad hoc and recurring data analyses to support operational and financial decision-making.
Partner with business leaders to link programs with financial plans, forecasts, and emerging results.
Analyze medical cost trends and identify claim cost drivers to uncover new opportunities.
Enhance business case and savings estimate models for deeper financial insights.
Contribute to reports and presentations that communicate complex findings in clear, actionable ways.
What We’re Looking For
Bachelor’s degree in a relevant field with 3+ years of experience in health insurance, healthcare analytics, or a related area (or equivalent combination of education and experience).
Strong proficiency in medical claims data analysis.
Advanced skills in Excel and experience with SQL, Access, or other query tools.
Ability to think critically, work independently, and communicate complex data insights clearly.
Familiarity with Business Intelligence tools (e.g., Tableau, Power BI) strongly preferred.
Why Join?
Competitive salary ($70,000K– 90,000K) plus 5% bonus potential.
Comprehensive benefits package including health, dental, vision, 401(k), life and disability coverage, tuition reimbursement, and flexible spending accounts.
Collaborative culture that values growth, professional development, and work-life balance.
Opportunity to make a tangible impact on healthcare outcomes through innovative analytics.
The MH Group is a full-service staffing agency.
Company DescriptionThe MH Group is a full-service staffing agency.
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4
Insurance Claims Specialist
77901 Victoria
$767 - $1251 per week
Liberty Mutual Insurance
Posted 10 days ago
Job Viewed
Job Description
We are seeking a detail-oriented and experienced Insurance Claims Specialist to manage and resolve insurance claims efficiently and professionally. The ideal candidate will have experience in claims investigation, policy interpretation, and claims negotiation. This is a remote role, allowing you to work from home while collaborating with a dynamic team.
Roles and Responsibilities
1.Investigate and process property, casualty, or specialty insurance claims.
2. Determine coverage, liability, and settlement amounts.
3. Communicate with claimants, policyholders, and third-party vendors.
4. Maintain accurate claim records and comply with regulations.
5. Negotiate settlements and facilitate timely claim resolution.
6. Investigate, evaluate, and process insurance claims (property, casualty, or specialty lines).
7. Participate in training and development programs to maintain licensing and industry knowledge.
8. Assess and adjust reserves as necessary during the claims lifecycle.
Reasons why You will Love This Role:
• Fully remote with flexible work setup
• Competitive salary and benefits
• Opportunities for career growth and professional development.
Company Details
Company Overview Liberty Mutual is a global diversified insurer headquartered in Boston, Massachusetts. It was founded in 1912 (originally as the Massachusetts Employees Insurance Association) and later renamed Liberty Mutual. As of 2024, the company reports annual consolidated revenue of around US50.2 billion and employs over 40,000 people in 28+ countries and economies. The company operates globally, with strong operations in the U.S. (especially in property & casualty insurance) and expanding international presence. Manage a caseload of routine to moderately complex claims from investigation through resolution. Make decisions about coverage, liability/compensability and negotiating settlements. Establish action plans using best practices, protocols, regulatory issues and available resources. Conduct investigations to verify coverage and determine damages. Work with claimants, policyholders, attorneys, third-parties (appraisers, providers, etc). Assess policy coverage issues, establish reserve requirements, adjust reserves as needed during claim lifecycle.
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5
Insurance Claims Specialist
Ronkonkoma, New York
Ultimate Care Assisted Living Management
Posted today
Job Viewed
Job Description
Job Description
Job Description
The Insurance Claims Specialist will work closely with the VP of Risk Management mitigating risks, promoting a safe environment for both residents and staff, supporting operational risk initiatives, and safeguarding company resources. This role is integral to supporting the financial health of the organization by collaborating closely with the finance team ensuring accurate invoicing, providing actionable data analysis, ensuring compliance and optimizing claims outcomes.
DUTIES AND KEY RESPONSIBILITIES :
Claims Management and Oversight
- Manage and oversee workers' compensation, EPLI, GL, and PL claims from initial reporting through resolution.
- Respond to inquiries and concerns regarding new and existing claims
- Conduct timely and thorough investigations, coordinating with internal and external stakeholders, requesting/reviewing witness statements, video footage etc. and ensure all claims are accurately documented and supported.
- Collaborate with claim and broker partners, build and maintain strong relationships to ensure effective claims handling and dispute resolution.
- Maintain clear, consistent communication with Vice President of Risk Management, various team members, business partners, and other stakeholders regarding claims handling and their resolutions.
Compliance and Reporting
- Ensure all claims processes adhere to state regulations and company policies, maintaining compliance with industry standards.
- Prepare and maintain regular reports on claims status, costs, and outcomes for internal review and regulatory purposes.
- Monitor claim trends and identify risk mitigation opportunities.
Financial Coordination and Invoicing
- Coordinate with the finance team to ensure accurate claims invoicing, payment tracking, and budgeting.
- Support the finance team with forecasting and financial planning related to insurance claims and associated expenses.
- Work with finance team to place and monitor appropriate reserves and allocate funds.
Data Analytics and Reporting
- Analyze claims data to provide insights into claim trends, financial impact, and risk management strategies.
- Develop and maintain dashboards and reporting tools to communicate claims data with key stakeholders.
- Use data insights to recommend and implement improvements to claims processes and cost-saving initiatives.
Collaboration and Communication
- Work closely with VP of Risk Management, finance, HR, and community leadership teams to streamline claims processing and minimize organizational risk.
- Serve as a primary point of contact for insurance carriers, third-party administrators, and internal teams on claims-related matters.
- Provide regular updates to management on claims status, strategic initiatives, and risk trends.
- Educate team members and on-site staff about claim reporting procedures, documentation best practices, and risk mitigation strategies.
- Assist in training sessions on safety and risk prevention, fostering a culture of proactive incident management.
QUALIFICATIONS:
- 3-5 years of experience in insurance claims management, preferably within the healthcare or assisted living industry.
- Associate’s degree required.
- Excellent customer service skills
- Strong analytical and problem-solving skills to investigate and diagnose claim driven issues
- Aptitude to investigate complaints for facts and recommend resolutions in a timely manner
- Exceptional interpersonal, verbal, and written communication skills
- Proven customer relationship and conflict resolution skills
- Ability to develop and maintain strong working relationships with internal and external parties
- Strong attention to detail and accuracy in data entry and record keeping
- Must be willing to travel to various community locations for meetings, investigations, and internal audits as required.
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6
Medical Insurance Claims Specialist
92108 Mission Valley, California
Robert Half
Posted today
Job Viewed
Job Description
Description We are looking for a dedicated Medical Insurance Claims Specialist to join our team on a contract basis in San Diego, California. In this role, you will manage insurance claims, verify patient eligibility, and ensure accurate processing of medical billing. This position requires strong communication skills, attention to detail, and a commitment to delivering excellent service to patients and healthcare professionals.
Responsibilities:
- Verify patients' insurance coverage, including eligibility, copayments, deductibles, and pre-authorization requirements.
- Submit and manage treatment authorizations, ensuring timely approvals and addressing denials or escalations.
- Communicate with patients to explain their insurance benefits, financial responsibilities, and address any concerns.
- Collaborate with billing staff to ensure accurate processing of claims based on verified insurance information.
- Maintain detailed documentation of insurance verification activities, including interactions with insurance providers and patients.
- Resolve discrepancies in coverage and authorization denials, escalating complex cases when necessary.
- Coordinate with healthcare providers and administrative teams to improve the patient experience.
- Ensure compliance with patient confidentiality regulations and organizational policies.
- Educate patients on out-of-pocket expenses and assist with inquiries about billing procedures. Requirements - High school diploma or equivalent required; associate or bachelor's degree preferred.
- Minimum of 1 year experience in insurance verification, medical billing, or healthcare administration.
- Proficiency with insurance verification software, electronic health records, and Microsoft Office applications.
- Strong communication skills, both verbal and written, with the ability to interact effectively with patients and insurance representatives.
- Excellent attention to detail and accuracy in documentation.
- Ability to work independently and collaboratively in a fast-paced environment.
- Familiarity with medical terminology and insurance billing codes is a plus.
- Knowledge of patient privacy laws and compliance regulations.
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app ( and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use ( .
Responsibilities:
- Verify patients' insurance coverage, including eligibility, copayments, deductibles, and pre-authorization requirements.
- Submit and manage treatment authorizations, ensuring timely approvals and addressing denials or escalations.
- Communicate with patients to explain their insurance benefits, financial responsibilities, and address any concerns.
- Collaborate with billing staff to ensure accurate processing of claims based on verified insurance information.
- Maintain detailed documentation of insurance verification activities, including interactions with insurance providers and patients.
- Resolve discrepancies in coverage and authorization denials, escalating complex cases when necessary.
- Coordinate with healthcare providers and administrative teams to improve the patient experience.
- Ensure compliance with patient confidentiality regulations and organizational policies.
- Educate patients on out-of-pocket expenses and assist with inquiries about billing procedures. Requirements - High school diploma or equivalent required; associate or bachelor's degree preferred.
- Minimum of 1 year experience in insurance verification, medical billing, or healthcare administration.
- Proficiency with insurance verification software, electronic health records, and Microsoft Office applications.
- Strong communication skills, both verbal and written, with the ability to interact effectively with patients and insurance representatives.
- Excellent attention to detail and accuracy in documentation.
- Ability to work independently and collaboratively in a fast-paced environment.
- Familiarity with medical terminology and insurance billing codes is a plus.
- Knowledge of patient privacy laws and compliance regulations.
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app ( and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use ( .
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7
Insurance Specialist
31144 Kennesaw, Georgia
Fresenius Medical Care North America
Posted 2 days ago
Job Viewed
Job Description
**PURPOSE AND SCOPE:**
Developing, experienced team member, supporting the strategic initiatives of the Financial Coordinator Program through knowledge of the eligibility rules for the American Kidney Fund's Health Insurance Premium Program (HIPP), the Indigent Waiver (IW), Employer Group Health Plans (EGHP), Medicare, Medicaid, Medigaps, Commercial Exchange, Commercial Individual, Medicare Advantage, and Veteran's Administration Health Plans. Support FMCNA's mission, vision, core values, and customer service philosophy. Adhere to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.
**PRINCIPAL DUTIES AND RESPONSIBILITIES:**
+ Under general supervision, follow established company policies and procedures and apply acquired job skills in performing duties. Primary duties are semi-routine in nature requiring full knowledge of general aspects of the job, with occasional deviation from accepted practice.
+ Serve as a liaison to the American Kidney Fund's Health Insurance Premium Program (HIPP). The purpose of the AKF HIPP is to provide health insurance grants to eligible ESRD patients on dialysis for the purpose of paying their Medicare Part B, Medicare Advantage, Medigap, Commercial Exchange, Commercial Individual, or COBRA medical premiums. HIPP Is supported 100% by provider contributions. Responsible for ensuring the efficacy of the AKF HIPP process.
+ Review tickets (requests) by term date for accuracy and required supporting documents. Communicate, and return for completion, all inaccurate and incomplete tickets directly with the Insurance Coordinator (ICs) on the ticket.
+ Process grants in the AKF Grant Management System (GMS) the same day for urgent grants due to term within 10 days and within 14 days of the term date for non-urgent grants.
+ Escalate policies at risk of termination to appropriate management and customer service representatives. Request overnight delivery of payments at risk of termination.
+ Provide weekly Check Report to ICs of checks issued their patients by AKF the week prior.
+ Run and distribute Return to Requestor reports weekly to ICs, IC Supervisors and IC Managers to remind ICs of requests that have been returned for grants that could not be processed or sent back as incomplete.
+ After weekly Check Status Report is uploaded and available, check for Grant Conflicts and resolve and issue to ensure discrepancies are addressed timely. Review processed grants to ensure all premium payments are made timely so that policies do not term.
+ Check weekly for grants processed that are not updated with a check number and issue date. Communicate any issues due to non-payment of processed grant to both AKF and ICs.
+ Receive and notify IC accordingly of returned checks from AKF, record on patient tab in applicable system, and overnight checks weekly to AKF. A new request is entered by the IS and processed in GMS if needed to cover premium(s) for payment returned.
+ 45-days prior to payment due date, run initial recurring grant request reports and distribute to appropriate IC for review. Once IC responds, release grants for payment as directed by the IC. Check weekly for recurring grants due to be released until month end to ensure grants that come up in queue are not missed and released for payment.
+ Forward copies of returned AKF checks received from AKF HIPP representatives to the IC assigned to the patient. Record on the patient tab in applicable system.
+ Transfer patients between FMC clinics in GMS upon request and notify all involved parties when transfer is complete.
+ Notify AKF HIPP representatives of any patient status changes and request cancellation of recurring grants if warranted.
+ Request checks to be voided and reissued if notified payment has not been received and cleared within 45-days. Create a new one-time request ticket for any check reissue request.
+ Assist the Support Services Manager with reports and projects as needed.
+ Indigent Waiver (IW) Approvals. Review all Indigent Waiver (IW) applications for patients with gaps in coverage to determine patient eligibility. The Indigent Waiver program purpose is to assist patient who are unable to obtain full insurance coverage and who do not have the financial resources to pau for their portion of medical services provided by FMCNA. Any patients who are believed to be eligible for insurance coverage or assistance of any type should be encouraged and expected to pursue such.
+ Receive completed IWs from the Insurance Coordinator (IC) via email and record receipt in system.
+ Review IW for completeness and accuracy according to IW procedure guidelines.
+ Ensure that IWs are reviewed within 30 days of receipt.
+ Forward approved IWs to RVP or DO to obtain approval signature.
+ Document status of approved IW in system through completion.
+ Maintain a source file of all IWs received and the status of each (approved, denied, pending additional documentation) and update on a daily basis.
+ Scan approved IWs into Document Imaging (DI).
+ Compile monthly reports, including all IWs approved both monthly and year-to- date, by the 5th of the following month and forward to the Support Service Manager, Insurance Coordination Manager and Self-Pay team.
+ Answer all email and voicemail communications within 24 hours of receipt. If urgent, must respond same day.
+ Assist with reports and projects as needed.
+ Escalate issues to supervisor for resolution, as deemed necessary.
+ Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
+ Assist with various projects as assigned by direct supervisor.
+ Other duties as assigned.
**Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.**
**PHYSICAL DEMANDS AND WORKING CONDITIONS** **:**
+ The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
+ Minimal travel required.
**EDUCATION:**
+ High School Diploma required
**EXPERIENCE** AND REQUIRED SKILLS:
+ 1-2 years related experience.
+ Knowledge of various insurance types.
+ Knowledge of dialysis industry a plus.
+ Excellent written and verbal skills.
+ Detail oriented.
+ Strong organizational and time management skills.
+ Proficient with PCs and Microsoft Office applications.
**Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.**
**EOE, disability/veterans**
Developing, experienced team member, supporting the strategic initiatives of the Financial Coordinator Program through knowledge of the eligibility rules for the American Kidney Fund's Health Insurance Premium Program (HIPP), the Indigent Waiver (IW), Employer Group Health Plans (EGHP), Medicare, Medicaid, Medigaps, Commercial Exchange, Commercial Individual, Medicare Advantage, and Veteran's Administration Health Plans. Support FMCNA's mission, vision, core values, and customer service philosophy. Adhere to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.
**PRINCIPAL DUTIES AND RESPONSIBILITIES:**
+ Under general supervision, follow established company policies and procedures and apply acquired job skills in performing duties. Primary duties are semi-routine in nature requiring full knowledge of general aspects of the job, with occasional deviation from accepted practice.
+ Serve as a liaison to the American Kidney Fund's Health Insurance Premium Program (HIPP). The purpose of the AKF HIPP is to provide health insurance grants to eligible ESRD patients on dialysis for the purpose of paying their Medicare Part B, Medicare Advantage, Medigap, Commercial Exchange, Commercial Individual, or COBRA medical premiums. HIPP Is supported 100% by provider contributions. Responsible for ensuring the efficacy of the AKF HIPP process.
+ Review tickets (requests) by term date for accuracy and required supporting documents. Communicate, and return for completion, all inaccurate and incomplete tickets directly with the Insurance Coordinator (ICs) on the ticket.
+ Process grants in the AKF Grant Management System (GMS) the same day for urgent grants due to term within 10 days and within 14 days of the term date for non-urgent grants.
+ Escalate policies at risk of termination to appropriate management and customer service representatives. Request overnight delivery of payments at risk of termination.
+ Provide weekly Check Report to ICs of checks issued their patients by AKF the week prior.
+ Run and distribute Return to Requestor reports weekly to ICs, IC Supervisors and IC Managers to remind ICs of requests that have been returned for grants that could not be processed or sent back as incomplete.
+ After weekly Check Status Report is uploaded and available, check for Grant Conflicts and resolve and issue to ensure discrepancies are addressed timely. Review processed grants to ensure all premium payments are made timely so that policies do not term.
+ Check weekly for grants processed that are not updated with a check number and issue date. Communicate any issues due to non-payment of processed grant to both AKF and ICs.
+ Receive and notify IC accordingly of returned checks from AKF, record on patient tab in applicable system, and overnight checks weekly to AKF. A new request is entered by the IS and processed in GMS if needed to cover premium(s) for payment returned.
+ 45-days prior to payment due date, run initial recurring grant request reports and distribute to appropriate IC for review. Once IC responds, release grants for payment as directed by the IC. Check weekly for recurring grants due to be released until month end to ensure grants that come up in queue are not missed and released for payment.
+ Forward copies of returned AKF checks received from AKF HIPP representatives to the IC assigned to the patient. Record on the patient tab in applicable system.
+ Transfer patients between FMC clinics in GMS upon request and notify all involved parties when transfer is complete.
+ Notify AKF HIPP representatives of any patient status changes and request cancellation of recurring grants if warranted.
+ Request checks to be voided and reissued if notified payment has not been received and cleared within 45-days. Create a new one-time request ticket for any check reissue request.
+ Assist the Support Services Manager with reports and projects as needed.
+ Indigent Waiver (IW) Approvals. Review all Indigent Waiver (IW) applications for patients with gaps in coverage to determine patient eligibility. The Indigent Waiver program purpose is to assist patient who are unable to obtain full insurance coverage and who do not have the financial resources to pau for their portion of medical services provided by FMCNA. Any patients who are believed to be eligible for insurance coverage or assistance of any type should be encouraged and expected to pursue such.
+ Receive completed IWs from the Insurance Coordinator (IC) via email and record receipt in system.
+ Review IW for completeness and accuracy according to IW procedure guidelines.
+ Ensure that IWs are reviewed within 30 days of receipt.
+ Forward approved IWs to RVP or DO to obtain approval signature.
+ Document status of approved IW in system through completion.
+ Maintain a source file of all IWs received and the status of each (approved, denied, pending additional documentation) and update on a daily basis.
+ Scan approved IWs into Document Imaging (DI).
+ Compile monthly reports, including all IWs approved both monthly and year-to- date, by the 5th of the following month and forward to the Support Service Manager, Insurance Coordination Manager and Self-Pay team.
+ Answer all email and voicemail communications within 24 hours of receipt. If urgent, must respond same day.
+ Assist with reports and projects as needed.
+ Escalate issues to supervisor for resolution, as deemed necessary.
+ Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
+ Assist with various projects as assigned by direct supervisor.
+ Other duties as assigned.
**Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.**
**PHYSICAL DEMANDS AND WORKING CONDITIONS** **:**
+ The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
+ Minimal travel required.
**EDUCATION:**
+ High School Diploma required
**EXPERIENCE** AND REQUIRED SKILLS:
+ 1-2 years related experience.
+ Knowledge of various insurance types.
+ Knowledge of dialysis industry a plus.
+ Excellent written and verbal skills.
+ Detail oriented.
+ Strong organizational and time management skills.
+ Proficient with PCs and Microsoft Office applications.
**Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.**
**EOE, disability/veterans**
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8
Insurance Specialist
90006 Los Angeles, California
City National Bank
Posted 2 days ago
Job Viewed
Job Description
*INSURANCE SPECIALIST*
WHAT IS THE OPPORTUNITY?
The Insurance Specialist will be responsible for managing and coordinating all insurance-related functions for the bank's commercial clients. This role involves evaluating insurance requirements, ensuring compliance with regulations and bank policies, and supporting clients in obtaining appropriate coverage for their financial lending activities.
WHAT WILL YOU DO?
* Evaluate and verify insurance policies for commercial loan clients to ensure adequate coverage and compliance with bank requirements.
* Act as a liaison between the bank, clients, and insurance agencies to resolve coverage issues and obtain necessary documentation.
* Ensure all insurance documents meet regulatory, legal, and bank-specific compliance standards.
* Provide guidance to commercial banking clients regarding insurance needs related to loan agreements, including flood, property, liability, and business interruption insurance.
* Collaborate with Relationship Managers and Loan Officers to support client onboarding and ongoing portfolio reviews.
* Evaluate and verify insurance policies for commercial loan clients to ensure adequate coverage and compliance with bank requirements.
* Act as a liaison between the bank, clients, and insurance agencies to resolve coverage issues and obtain necessary documentation.
* Ensure all insurance documents meet regulatory, legal, and bank-specific compliance standards.
* Provide guidance to commercial banking clients regarding insurance needs related to loan agreements, including flood, property, liability, and business interruption insurance.
WHAT DO YOU NEED TO SUCCEED?
*Required Qualifications**
* Bachelor's Degree or equivalent
* Minimum 3-5 years experience in Commercial Banking, insurance or risk management, preferably in a financial institution setting.
* Previous client-facing roles is preferred.
*Additional Qualifications*
* Project Management skills, ability to prioritize tasks and adapt to changing priorities
* Organizational and time management skills
* Recommended experience: Prior closing experience, credit experience or understanding of experience
* Understanding of bank policies and procedures relating to the satisfaction of Insurance conditions, documents, and services
*WHAT'S IN IT FOR YOU?*
*Compensation*Starting base salary: $34.55 - $55.19 per hour. Exact compensation may vary based on skills, experience, and location. This job is eligible for bonus and/or commissions.
*Benefits and Perks*
At City National, we strive to be the best at whatever we do, including the benefits and perks we offer our colleagues including:
* Comprehensive healthcare coverage, including Medical, Dental and Vision plans, available the first of the month following start date
* Generous 401(k) company matching contribution
* Career Development through Tuition Reimbursement and other internal upskilling and training resources
* Valued Time Away benefits including vacation, sick and volunteer time
* Specialized health and family planning benefits including fertility benefits, and cancer, diabetes and musculoskeletal support programs
* Career Mobility support from a dedicated recruitment team
* Colleague Resource Groups to support networking and community engagement
Get a more detailed look at our US
Since day one we've always gone further than the competition to help our clients, colleagues and communities flourish. City National Bank was founded in 1954 by entrepreneurs for entrepreneurs and that legacy of integrity, community and unparalleled client relationships continues today. City National is a subsidiary of Royal Bank of Canada, one of North America's leading diversified financial services companies. To learn more about City National and our dynamic company culture, visit us at AND EQUAL OPPORTUNITY EMPLOYMENT*
City National Bank fosters an inclusive environment where all forms of diversity are valued and leveraged to make us a better company and employer. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, national origin, disability, veteran status or other basis protected by law.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
*Represents basic qualifications for the position. To be considered for this position, you must at least meet the required qualifications. careers.cnb.com accepts applications on an ongoing basis, until filled.
Unless otherwise indicated as fully remote, reporting into a designated City National location is an essential function of the job.
WHAT IS THE OPPORTUNITY?
The Insurance Specialist will be responsible for managing and coordinating all insurance-related functions for the bank's commercial clients. This role involves evaluating insurance requirements, ensuring compliance with regulations and bank policies, and supporting clients in obtaining appropriate coverage for their financial lending activities.
WHAT WILL YOU DO?
* Evaluate and verify insurance policies for commercial loan clients to ensure adequate coverage and compliance with bank requirements.
* Act as a liaison between the bank, clients, and insurance agencies to resolve coverage issues and obtain necessary documentation.
* Ensure all insurance documents meet regulatory, legal, and bank-specific compliance standards.
* Provide guidance to commercial banking clients regarding insurance needs related to loan agreements, including flood, property, liability, and business interruption insurance.
* Collaborate with Relationship Managers and Loan Officers to support client onboarding and ongoing portfolio reviews.
* Evaluate and verify insurance policies for commercial loan clients to ensure adequate coverage and compliance with bank requirements.
* Act as a liaison between the bank, clients, and insurance agencies to resolve coverage issues and obtain necessary documentation.
* Ensure all insurance documents meet regulatory, legal, and bank-specific compliance standards.
* Provide guidance to commercial banking clients regarding insurance needs related to loan agreements, including flood, property, liability, and business interruption insurance.
WHAT DO YOU NEED TO SUCCEED?
*Required Qualifications**
* Bachelor's Degree or equivalent
* Minimum 3-5 years experience in Commercial Banking, insurance or risk management, preferably in a financial institution setting.
* Previous client-facing roles is preferred.
*Additional Qualifications*
* Project Management skills, ability to prioritize tasks and adapt to changing priorities
* Organizational and time management skills
* Recommended experience: Prior closing experience, credit experience or understanding of experience
* Understanding of bank policies and procedures relating to the satisfaction of Insurance conditions, documents, and services
*WHAT'S IN IT FOR YOU?*
*Compensation*Starting base salary: $34.55 - $55.19 per hour. Exact compensation may vary based on skills, experience, and location. This job is eligible for bonus and/or commissions.
*Benefits and Perks*
At City National, we strive to be the best at whatever we do, including the benefits and perks we offer our colleagues including:
* Comprehensive healthcare coverage, including Medical, Dental and Vision plans, available the first of the month following start date
* Generous 401(k) company matching contribution
* Career Development through Tuition Reimbursement and other internal upskilling and training resources
* Valued Time Away benefits including vacation, sick and volunteer time
* Specialized health and family planning benefits including fertility benefits, and cancer, diabetes and musculoskeletal support programs
* Career Mobility support from a dedicated recruitment team
* Colleague Resource Groups to support networking and community engagement
Get a more detailed look at our US
Since day one we've always gone further than the competition to help our clients, colleagues and communities flourish. City National Bank was founded in 1954 by entrepreneurs for entrepreneurs and that legacy of integrity, community and unparalleled client relationships continues today. City National is a subsidiary of Royal Bank of Canada, one of North America's leading diversified financial services companies. To learn more about City National and our dynamic company culture, visit us at AND EQUAL OPPORTUNITY EMPLOYMENT*
City National Bank fosters an inclusive environment where all forms of diversity are valued and leveraged to make us a better company and employer. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, national origin, disability, veteran status or other basis protected by law.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
*Represents basic qualifications for the position. To be considered for this position, you must at least meet the required qualifications. careers.cnb.com accepts applications on an ongoing basis, until filled.
Unless otherwise indicated as fully remote, reporting into a designated City National location is an essential function of the job.
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9