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JOB SUMMARY: Responsible for auditing and monitoring company processes. Meets with stakeholders to review corrective action and obtain resolution. Conducts follow-up audits to ensure corrective actions have addressed the root cause to prevent errors from recurring. This position will also provide financial supporting functions to the Director of Pharmacy such as high-alert drug notifications and weekly invoice comparisons. KEY RESPONSIBILITIES: Audit and monitor company processes and busi ...Read more about Pharmacy - Pharmacy Auditor Coordinator 146-1013More
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JOB SUMMARY: This position is a part of a team that provides support to our sales and retention reps in the form of data gathering, data entry and analysis, proposal and financial exhibit development, and coordinates with internal and external customers to install and renew employer group benefits. KEY RESPONSIBILITIES: Monitor email and respond to Request for Proposals (RFPs): Gather benefit information from a variety of sources, coordinates response, inputs data and maintains all appropria ...Read more about Marketing - Sales & Retention Support 110-1012More
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Tulsa, OK, USA ● Req #527Thursday, May 2, 2024JOB SUMMARY: Responsible for providing assistance to Executive Level Officer(s) on all scheduling, travel arrangements, meeting preparation, report compilations and special projects. Provides administrative support including all private correspondence, and maintaining confidential files and records forExecutive Level Officer(s). KEY RESPONSIBILITIES: Schedules, coordinates and organizes various meetings for Executive Level Officer(s). Transcribes and prepares correspondence, memorandums, ...Read more about Administration - Executive Administrative Assistant 120-1002More
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JOB SUMMARY: To provide administrative and clerical support to ensure the efficient operation of the department. KEY RESPONSIBILITIES: •General clerical duties including copying, scanning and faxing. •Develops and maintains files and logs as related to department needs. •Prepares mailings, forms and correspondence. •Complies and provides information as related to department to appropriate personnel. •Performs other duties as assigned. QUALIFICATIONS: •Knowledge of relevant software application ...Read more about Mailroom - Clerical Support Specialist 138-1001More
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Tulsa, OK, USA ● Req #525Thursday, May 2, 2024JOB SUMMARY: The Customer Service Supervisor will build a strong team of Customer Service Representatives and shape staff behaviors to accomplish desired results to meet the expectations and needs of our members, providers and internal customers. You will be responsible for providing ongoing coaching to inspire our Customer Service Representatives to deliver exceptional customer service as well as coaching to develop CSRs in their current role or to take on additional responsibilities. You will ...Read more about Customer Service - Supervisor Customer Service 105-4000More
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Tulsa, OK, USA ● Req #497Thursday, May 2, 2024JOB SUMMARY: Responsible for selling Medicare products and Individual Health Plan products via telemarketing calls and person-to-person meetings, including seminars. KEY RESPONSIBILITIES: Discuss products and benefits with eligible beneficiaries on a person to person basis in various settings. Makes outbound calls, as allowed, to prospects to answer questions and to schedule further sales follow up calls. Receives inbound calls from prospective enrollees, answer questions about company pr ...Read more about Individual Marketing - Health Plan Consultant 176-1008More
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Tulsa, OK, USA ● Req #355Wednesday, May 1, 2024JOB SUMMARY: Directs the Data Analytics and Reporting, Actuarial, and Underwriting activities of the Company, including product and bid filing activities. Directs the development and analysis of the financial budget, with particular emphasis on premiums, medical costs and provider reimbursement plans. Directs and manages the analysis of medical, pharmacy, and other claim costs and related expenses, including utilization and other trends affecting the company. Directs and manages the estimation ...Read more about Accounting/Finance - Director Actuarial & AnalyticsMore
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Tulsa, OK, USA ● Req #521Monday, April 29, 2024JOB SUMMARY: The Software Engineer II will build out the next generation of our platform. As a Software Engineer II, you are expected to work independently, and within teams, leading the development of software features. You will be involved with the early stages of mentoring other team members and helping with identifying process improvements for the team. KEY RESPONSIBILITIES: •Implements features of the application and is proficient in one or more of the feature or components. •Leads ind ...Read more about Information Technology - Software Engineer II 130-2051More
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JOB SUMMARY: Responsible for training of all non-exempt personnel in the Claims, Enrollment, and Customer Service departments on procedures, policies, and mode of operations. This will be done by directly delivering content, developing content for learning, arranging for specialists to deliver content and by measuring the progress of the new hire. The trainer will also assist current employees with residual training needs or training on new processes, procedures or products. KEY RESPONSIBIL ...Read more about Training - Trainer 103-1004More
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Tulsa, OK, USA ● Req #457Thursday, April 25, 2024JOB SUMMARY: Responsible for conducting clinical behavioral health assessments and/or brief counseling of clients. Make referrals and conducts referral assessments, and follow-up. Provide training and/or workshops to EAP companies. KEY RESPONSIBILITIES: Conducts clinical behavioral health assessments and/or brief counseling of clients and makes referrals to contracted providers for select diagnoses. Monitor and manage affiliate cases to insure appropriate utilization of the EAP. Conducts ...Read more about Employee Assistance Program - EAP Counselor 151-2004More
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JOB SUMMARY: The pharmacy intern will provide support to the CommunityCare Pharmacy Department by participating in Medicare Stars, Medication Adherence, and Medication Therapy Management Programs. This position will also provide clinical support for Pharmacy & Therapeutics, Prior Authorizations, and other clinical reviews and research as needed. Effective communication is an important part of this role. The position will be interacting with members, providers, and other departments within Commu ...Read more about Pharmacy- Seasonal Intern - PharmacyMore
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Tulsa, OK, USA ● Req #331Wednesday, April 24, 2024JOB SUMMARY: The Manager of Data Reporting and Report Development is responsible for architecting advanced data solutions while directing a team of data analysts in providing analytical, operational, cost and quality metrics to both internal and external customers, including regulatory reporting to CMS. This role acts as the Architect of data warehouse data marts and self-service reporting platform solutions. Additionally, this role supervises and manages both a team of health data analysts, ...Read more about Reporting - Manager Data Reporting & Report Development 135-5003More
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Tulsa, OK, USA ● Req #511Monday, April 22, 2024JOB SUMMARY: This position is responsible for maintaining the entry and maintenance of the customer database. Maintains customer files and data according to regulations. KEY RESPONSIBILITIES: Generates customer correspondence and distributes information. Creates and maintains customer eligibility in the database. Reviews information to determine requirements. Reviews and processes enrollment information to ensure compliance with all regulations. Accountable for meeting quality and production ...Read more about Enrollment Services - Enrollment Processor 160-1028More
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JOB SUMMARY: This non-clinical position supports the department by performing a broad range of clerical duties. KEY RESPONSIBILITIES: Prepares correspondence to members, providers, and facilities. Provides follow up with providers and members as needed. Reviews service requests for completeness of information. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers non-clinical questions and takes information, or refers callers to appropriate ...Read more about Medical Management - Intake Coordinator 145-1021More
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JOB SUMMARY: This non-clinical position supports the department by performing a broad range of clerical duties. KEY RESPONSIBILITIES: Prepares correspondence to members, providers, and facilities. Provides follow up with providers and members as needed. Reviews service requests for completeness of information. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers non-clinical questions and takes information, or refers callers to appropriate ...Read more about Medical Management - Intake Coordinator 145-1031More
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JOB SUMMARY: The Complex Claims Specialist is responsible for examining claims that require review prior to being adjudicated. Claims are generally of the largest dollar value and require extreme attention to detail and strong knowledge of claims processing. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. The Complex Claims Specialist will generally handle claims involving multiple lines of busi ...Read more about Claims HMO - Complex Claims Specialist 140-1039More
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JOB SUMMARY: Responsible for performing health intake functions, directing members to services needed. KEY RESPONSIBILITIES: •Verifies member eligibility, line of business and network affiliations for members and providers. Determines if the call is clinical and requires transfer to a clinical staff person. Will inform callers, including members, facility personnel, physicians, or other health care professionals of the utilization requirements and procedures. •Makes initial referrals that ...Read more about Behavioral Health - Intake Specialist 150-1003More
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Tulsa, OK, USA ● Req #519Monday, April 22, 2024JOB SUMMARY: The Customer Service Supervisor will build a strong team of Customer Service Representatives and shape staff behaviors to accomplish desired results to meet the expectations and needs of our members, providers and internal customers. You will be responsible for providing ongoing coaching to inspire our Customer Service Representatives to deliver exceptional customer service as well as coaching to develop CSRs in their current role or to take on additional responsibilities. You will ...Read more about Customer Service - Supervisor Customer Service 105-4004More
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Tulsa, OK, USA ● Req #487Saturday, April 20, 2024JOB SUMMARY: This position is responsible for supporting the grievance and appeals activities pertaining to all written inquiries from members and providers requesting resolution through the grievance and appeals process. This includes claims and authorization research. Duties are varied and including typing, filing, photocopying, telephone follow-up, data entry, and preparation of information for presentation at committee meetings. KEY RESPONSIBILITIES: Initiate research for grievance an ...Read more about Quality Improvement - Intake Coordinator 195-1012More
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JOB SUMMARY: Responsible for performing health intake functions, directing members to services needed. KEY RESPONSIBILITIES: •Verifies member eligibility, line of business and network affiliations for members and providers. Determines if the call is clinical and requires transfer to a clinical staff person. Will inform callers, including members, facility personnel, physicians, or other health care professionals of the utilization requirements and procedures. •Makes initial referrals that ...Read more about Behavioral Health - Intake Specialist 150-1002More
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JOB SUMMARY: The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency. KEY RESPONSIBILITIES: Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making i ...Read more about Claims HMO - Claims Examiner 140-1025More
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Tulsa, OK, USA ● Req #204Saturday, April 20, 2024JOB SUMMARY: The Sr. Software Engineer will build out the next generation of our platform. As a Sr. Software Engineer, you are expected to work independently, and within teams, leading the development of software features. Ability to prioritize well, communicate clearly, have a consistent track record of delivery, and excellent software engineering skills. You will be involved with mentoring other team members and helping with identifying process improvements for the team. KEY RESPONSIBILITIES:D ...Read more about Information Technology - Senior Software Engineer 130-2014More
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Tulsa, OK, USA ● Req #469Tuesday, February 27, 2024JOB SUMMARY: The Managed Care Clinical Pharmacist will provide clinical pharmacy support to the CommunityCare Pharmacy Department including development of criteria for medications requiring a prior authorization, management of the drug utilization protocol, clinical support for the CMS Medication related STARs Measures, Medication Therapy Management (MTM) outreach, and other clinical duties as needed. The ability to influence members and providers to act is important. This position will also wo ...Read more about Pharmacy - Managed Care Clinical Pharmacist 146-2002More
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Tulsa, OK, USA ● Req #470Friday, February 23, 2024JOB SUMMARY: Responsible for completing out-bound calls and other member outreach opportunities to select members and documenting efforts. This role spends 100% of time on quality program activities. May require extended, or multiple, phone calls to members. May require work on additional projects as directed. KEY RESPONSIBILITIES: Contact members selected for intervention. Assist members with developing a plan to resolve identified HEDIS gaps in care, setting up appointments, getting t ...Read more about Quality Improvement - Member Engagement Specialist 195-1008More
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Tulsa, OK, USA ● Req #471Friday, February 23, 2024JOB SUMMARY: Responsible for completing out-bound calls and other member outreach opportunities to select members and documenting efforts. This role spends 100% of time on quality program activities. May require extended, or multiple, phone calls to members. May require work on additional projects as directed. KEY RESPONSIBILITIES: Contact members selected for intervention. Assist members with developing a plan to resolve identified HEDIS gaps in care, setting up appointments, getting t ...Read more about Quality Improvement - Member Engagement Specialist 195-1017More