Location: Remote Pennsylvania
Company: Humana
semi-routine assignments. Essential Duties and Responsibilities: Assist in setting up and maintaining hospice/facility/shop relationships under the direction of the shop Claims Team Leaders & the shop Claims (Support Services) Manager Assist pharmacies with claims adjudication Complete incoming tasks as assigned by the shop Claims Team Leaders and the shop Claims (Support Services) Manager Obtain all necessary information for facilities and their related pharmacies Assist the Call Center management team with projects to enhance the workflow and success of the Call Center Assist Customer Service team with claims research/resolution Location: You must reside in PA, CT, Washington DC, DE, FL, GA,
KY, MD, NC, NJ, SC, OH, TN, or VA to work remotely.
Shift: Monday-Friday 2:30pm-11pm EST. Flexibility to work alternating weekends between the hours of 9am-8pm EST.
Flexibility to work 2 holidays per year. Use your skills to make an impact RESPONSIBILITIES (include but are not limited to): Billing: Assist pharmacies with claims adjudication by adjusting/correcting authorizations in dispensing systems and PBM systems Ensure timely adjudication of prescription claims through PBM systems Contact hospices for authorizations/approvals for submitted claims where necessary Ensure accuracy of patient profile data including related/not related status, authorization status, etc Research
and correct shop invoices from hospices Demonstrate basic understanding of Enclara Pharmacia standard/custom formularies Understand formulary and billing platform differences (PD vs.
FFS) from hospice to hospice Assist Customer Service team with claims research/resolution via dispensing systems, PBM systems and fax systems Evaluate compound claims for proper ingredients/qtys/cost and ensure timely claims adjudication Research claims for hospice/shop audits New Hospice Start-Ups: Complete assigned facility/shop spreadsheet by contacting both the facilities and pharmacies to verify accuracy of all information provided. Coordinate all information for facility pharmacies including verification of PBM systems.
Update facility shop spreadsheets and implementation team members on the progress with these pharmacies. Communicate with the facility pharmacies on proper billing procedures and contact information for rejected claims. New Facilities: Gather partial information from Call Center on facilities not listed and obtain correct information to be entered into the database. Link facilities to their respective hospices once all information is obtained. Assist with Confirmation Fax reports to update facility and shop relationships and demographic information.
Qualifications: Strong verbal and written communication skills, including the ability to tailor communication to audience. Self-motivated, organized Strong attention to detail Team player Problem-solving skills and ability to follow through on tasks assigned Ability to handle multiple tasks, meet deadlines, and follow-up timely. Required Education and/or Experience: 1+ years of shop Technician experience Strong knowledge working with shop claims judication Must have experience with electronic claims submissions OR be a current internal Enclara Pharmacia associate Preferred Experience: PBM experience Dispensing system experience CPh T or EXCPT Drug knowledge High school diploma Interview Format: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability.
Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected , you will receive correspondence inviting you to participate in a Modern Hire backssment. You will have a set of questions and you will provide responses to each question.
You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed and you will subsequently be informed if you will be moving forward to next round. Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from xyz X@ with instructions to add the information into the application at Humana's secure website. 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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $37,200 - $51,200 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 Enclara: Pharmacia Enclara Pharmacia is the nation's largest full-service hospice and palliative care shop Benefits Manager, offering compassionate and cost-effective services to our most vulnerable patients.
As a wholly owned subsidiary of Humana, Enclara works closely with hospice providers to reduce shop costs, improve patient care and support caregivers through digital innovations, flexible medication access, one-on-one clinical support and excellent customer service. About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our Center Well healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.
These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, interaction, interactionual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran.
It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, interaction, interactionual orientation, gender identity, national origin, age, marital status, genetic information, 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.
Requisition #: R-325692tcv57hlu2
the following position in our NYC office. RESPONSIBILITIES: Be part of a collaborative team. Work with a wide range of clients. Provide innovative solutions to drive operational excellence as a core attribute throughout CSS. Continually maintain and refresh staff development plans and talent maps ensuring regular reviews.
Build strong relationships with stakeholders in broking, broking support, and regional offices Participate in and/or lead the charge for new automation for our clients. Measure performance for clients using messaging and provide regular feedback to them and the CSS client teams on those accounts. Establish clear goals and targets for implementing inbound messaging with
clients. Lead regional team of technicians working to test and implement inbound messaging. QUALIFICATIONS: BA/BS degree in finance, economics, or other business-related areas.
At least 5+ years of applicable experience. Analytical skills and attention to detail, ability to multi-task, manage multiple priorities and work in a rapidly changing environment. Electronic messaging experience in Insurance or Reinsurance. Proficiency in Excel and Microsoft office. Previous experience managing or directing others work. Writing and communication skills. Consultative and sales skills a plus. 1. ) Please elaborate candidate's Electronic messaging experience in Insurance or Reinsurance 2. ) Please
provide the link to candidates Linked In profile: 3. ) What is the candidates work authorization status?
4. ) What is the candidates highest level of education? 5. ) Has the candidate applied or been interviewed for any role with this company in the past? If so, please provide details. 6. ) What is the candidates desired total compensation? (Please specify base salary mission/bonus expectation) 7. ) Where is the candidate located? If candidate is not near the job location, please explain relocation plan in detail (e. g. timeline, relocating with family, selling/buying property)
answering questions, and resolving issues that may arise. The Commercial Lines Account Manager will work closely with the sales team to understand client and prospect needs, submit coverage specifications, obtain quotes from potential carriers, and negotiate/secure the best carrier coverage.
The role offers a competitive salary, attractive benefits and a flexible hybrid work style of 3 days in the office and 2 days from home. Pay Range: $85,000 - $110,000 DOE Responsibilities: Manage accounts, including coordinating services, answering questions, and resolving problems Work closely with the sales team to understand client and prospect needs Submit coverage specifications and obtain
quotes from potential carriers for new and renewal business Maintain accounts/policies Research and resolve any coverage issues, audit issues, or billing discrepancies Support new and existing clients with any inquiries Negotiate and secure the best carrier coverage based on clients' needs Remarket accounts in construction, servicing restaurants and servicing them Requirements: At least 3 years of experience in Commercial Insurance Experience as a Commercial Lines Account Executive is preferred Must hold a Property/Casualty License Experience with construction, restaurants, habitational commercial real estate customer types Experience working with AMS360 is preferred Bachelor's degree
is preferred Benefits: BCBS Health Insurance - 60% coverage for employee Group life insurance 401k with 3% match Vacation/PTO/Sick - 2 weeks Paid holidays - 7 or 8 with 2 floating holidays Incentive program for commercial lines Holiday bonus If you're looking for a challenging but rewarding career, apply for this position today!
#INDOPS #LI-POST #LI-HYBRID
U. S. economy with our goal to reach Real Zero carbon emissions from our operations by 2045 while improving customer affordability and reliability. Are you interested in creating a cleaner environment for future generations? Join our world-class, innovative team today.
Position Specific Description The Senior Insurance Auditor will be based in our Juno Beach office and will report to the Chief Compliance Officer of Palms Insurance and will conduct financial, operational, and compliance audits and advisory projects across all areas of our business. This challenging position will provide consultative support to business partners to identify solutions to address audit findings, and opportunities
for control improvements with the objective of mitigating risk and improving financial and operational performance. Audit areas may include Accounting, IT, Finance, Operations, Claims, and TPA.
Responsibilities will also include advising management on creating/updating process narratives, and flowcharts, performing walkthroughs, control testing, updating deficiency reports, providing control updates to management periodically, documenting action plans, and assisting process owners on ways to improve their processes and working with external auditors as required. The role requires a strong insurance and financial mindset, ability to build good working relationships with process owners
and management, effective communication skills and ability to multi-task when required.
Bachelor's degree in Accounting (or similar major), experience with insurance audit processes, procedures and methodologies and insurance carrier or broker experience. In turn for your hard work and excellent audit performance, we provide competitive pay/benefits, work life balance and opportunities for advancement across the organization. Job Overview Employees in this position contribute to audit and controls consultation projects by identifying and documenting risk exposure, processes and controls related to insurance, providing controls recommendations and best practices, and also testing manual and systematic controls.
Employees document audit results in work papers and report audit results to Management. Job Duties & Responsibilities Establish an insurance audit framework/charter, including evaluating internal processes and controls, meeting audit objectives within a scheduled time frame Create audit guidelines, questionnaires, and report templates to be utilized in all audits to maintain consistency Conduct or oversee Finance, Claims, Compliance, Operations, IT/Data Security & Retention, OFAC compliance Recommends process improvements Communicates verbally and in writing, with coworkers, Management, and customers Recommend process improvements Assist in the presentation of verbal and written audit reports to Management Partner with Next Era Internal Audit team.
Performs other job-related duties as assigned Job Overview This job Identifies, evaluates, and improves the effectiveness of company governance, risk management, and financial reporting controls and operational efficiencies. Job Duties & Responsibilities Oversees and directs a team of internal auditors responsible for multiple audits, SOX control testing and related reporting Meets and consults with business unit management on audit related matters Advises and provides insight to Executive Management on related audit findings Presents Audit Committee with an independent appraisal of the adequacy and effectiveness of the company's system of internal controls Performs other job-related duties as assigned Required Qualifications High School Grad / GEDBachelor's or Equivalent ExperienceExperience:10+ yearsSupervisor/Management Experience:5+ years Preferred Qualifications Certified Public Accountant (CPA)Master's Degree Employee Group: Exempt Employee Type: Full Time Job Category: Audit Organization: Palms Management Services, LLC Relocation Provided: Yes, if applicable Next Era Energy is an Equal Opportunity Employer.
Qualified applicants are considered for employment without regard to race, color, age, national origin, religion, marital status, interaction, interactionual orientation, gender identity, gender expression, genetics, disability, protected veteran status or any other basis prohibited by law. We are committed to a diverse and inclusive workplace. Next Era Energy and provides reasonable accommodation in its application and selection process for qualified individuals, including accommodations related to compliance with conditional job offer requirements, consistent with federal, state, and local laws.
Supporting medical or religious documentation will be required where applicable and permitted by applicable law. To request a reasonable accommodation, please send an e-mail to , providing your name, telephone number and the best time for us to reach you. Alternatively, you may call -xyz X. Please do not use this line to inquire about your application status. Next Era Energy will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.
Next Era Energy does not accept any unsolicited resumes or referrals from any third-party recruiting firms or agencies. Please see our for more information. #LI-FB1 PDN-99de5da5-edc-0c3edf69d9f3
Mail/Calendar Soft Skill requirements (team fit/personality requirements) Exceptional Organizational Skills Able to Multi-task Strong Communication Skills Able to build and maintain strong working relationships1.
) Has the candidate applied or been interviewed for any role with this company in the past?
If so, please provide details. 2. ) Where is the candidate located? If candidate is not near the job location, please explain relocation plan in detail (e. g. timeline, relocating with family, selling/buying property) 3. ) What is the candidates desired total compensation? (Please specify base salary mission/bonus expectation) 4. ) Please provide the link to candidates Linked In
profile: 5. ) What is the candidates highest level of education? 6. ) What is the candidates work authorization status? 7. ) Is the candidate open and willing to travel upto 50% of time?
8. ) Please elaborate on the candidate's CAPPS programming knowledge and experience. Skills Intermediate Microsoft office skills Excel - Pivot Tables; Formulas Power Point - Able to edit or create Power Point Outlook Mail/Calendar Soft Skill requirements (team fit/personality requirements) Exceptional Organizational Skills Able to Multi-task Strong Communication Skills Able to build and maintain strong working relationships.
the following position in our NYC office. RESPONSIBILITIES: Be part of a collaborative team. Work with a wide range of clients. Provide innovative solutions to drive operational excellence as a core attribute throughout CSS. Continually maintain and refresh staff development plans and talent maps ensuring regular reviews.
Build strong relationships with stakeholders in broking, broking support, and regional offices Participate in and/or lead the charge for new automation for our clients. Measure performance for clients using messaging and provide regular feedback to them and the CSS client teams on those accounts. Establish clear goals and targets for implementing inbound messaging with
clients. Lead regional team of technicians working to test and implement inbound messaging. QUALIFICATIONS: BA/BS degree in finance, economics, or other business-related areas.
At least 5+ years of applicable experience. Analytical skills and attention to detail, ability to multi-task, manage multiple priorities and work in a rapidly changing environment. Electronic messaging experience in Insurance or Reinsurance. Proficiency in Excel and Microsoft office. Previous experience managing or directing others work. Writing and communication skills. Consultative and sales skills a plus. 1. ) Please elaborate candidate's Electronic messaging experience in Insurance or Reinsurance 2. ) Please
provide the link to candidates Linked In profile: 3. ) What is the candidates work authorization status?
4. ) What is the candidates highest level of education? 5. ) Has the candidate applied or been interviewed for any role with this company in the past? If so, please provide details. 6. ) What is the candidates desired total compensation? (Please specify base salary mission/bonus expectation) 7. ) Where is the candidate located? If candidate is not near the job location, please explain relocation plan in detail (e. g. timeline, relocating with family, selling/buying property)
answering questions, and resolving issues that may arise. The Commercial Lines Account Manager will work closely with the sales team to understand client and prospect needs, submit coverage specifications, obtain quotes from potential carriers, and negotiate/secure the best carrier coverage.
The role offers a competitive salary, attractive benefits and a flexible hybrid work style of 3 days in the office and 2 days from home. Pay Range: $85,000 - $110,000 DOE Responsibilities: Manage accounts, including coordinating services, answering questions, and resolving problems Work closely with the sales team to understand client and prospect needs Submit coverage specifications and obtain
quotes from potential carriers for new and renewal business Maintain accounts/policies Research and resolve any coverage issues, audit issues, or billing discrepancies Support new and existing clients with any inquiries Negotiate and secure the best carrier coverage based on clients' needs Remarket accounts in construction, servicing restaurants and servicing them Requirements: At least 3 years of experience in Commercial Insurance Experience as a Commercial Lines Account Executive is preferred Must hold a Property/Casualty License Experience with construction, restaurants, habitational commercial real estate customer types Experience working with AMS360 is preferred Bachelor's degree
is preferred Benefits: BCBS Health Insurance - 60% coverage for employee Group life insurance 401k with 3% match Vacation/PTO/Sick - 2 weeks Paid holidays - 7 or 8 with 2 floating holidays Incentive program for commercial lines Holiday bonus If you're looking for a challenging but rewarding career, apply for this position today!
#INDOPS #LI-POST #LI-HYBRID
U. S. economy with our goal to reach Real Zero carbon emissions from our operations by 2045 while improving customer affordability and reliability. Are you interested in creating a cleaner environment for future generations? Join our world-class, innovative team today.
Position Specific Description The Senior Insurance Auditor will be based in our Juno Beach office and will report to the Chief Compliance Officer of Palms Insurance and will conduct financial, operational, and compliance audits and advisory projects across all areas of our business. This challenging position will provide consultative support to business partners to identify solutions to address audit findings, and opportunities
for control improvements with the objective of mitigating risk and improving financial and operational performance. Audit areas may include Accounting, IT, Finance, Operations, Claims, and TPA.
Responsibilities will also include advising management on creating/updating process narratives, and flowcharts, performing walkthroughs, control testing, updating deficiency reports, providing control updates to management periodically, documenting action plans, and assisting process owners on ways to improve their processes and working with external auditors as required. The role requires a strong insurance and financial mindset, ability to build good working relationships with process owners
and management, effective communication skills and ability to multi-task when required.
Bachelor's degree in Accounting (or similar major), experience with insurance audit processes, procedures and methodologies and insurance carrier or broker experience. In turn for your hard work and excellent audit performance, we provide competitive pay/benefits, work life balance and opportunities for advancement across the organization. Job Overview Employees in this position contribute to audit and controls consultation projects by identifying and documenting risk exposure, processes and controls related to insurance, providing controls recommendations and best practices, and also testing manual and systematic controls.
Employees document audit results in work papers and report audit results to Management. Job Duties & Responsibilities Establish an insurance audit framework/charter, including evaluating internal processes and controls, meeting audit objectives within a scheduled time frame Create audit guidelines, questionnaires, and report templates to be utilized in all audits to maintain consistency Conduct or oversee Finance, Claims, Compliance, Operations, IT/Data Security & Retention, OFAC compliance Recommends process improvements Communicates verbally and in writing, with coworkers, Management, and customers Recommend process improvements Assist in the presentation of verbal and written audit reports to Management Partner with Next Era Internal Audit team.
Performs other job-related duties as assigned Job Overview This job Identifies, evaluates, and improves the effectiveness of company governance, risk management, and financial reporting controls and operational efficiencies. Job Duties & Responsibilities Oversees and directs a team of internal auditors responsible for multiple audits, SOX control testing and related reporting Meets and consults with business unit management on audit related matters Advises and provides insight to Executive Management on related audit findings Presents Audit Committee with an independent appraisal of the adequacy and effectiveness of the company's system of internal controls Performs other job-related duties as assigned Required Qualifications High School Grad / GEDBachelor's or Equivalent ExperienceExperience:10+ yearsSupervisor/Management Experience:5+ years Preferred Qualifications Certified Public Accountant (CPA)Master's Degree Employee Group: Exempt Employee Type: Full Time Job Category: Audit Organization: Palms Management Services, LLC Relocation Provided: Yes, if applicable Next Era Energy is an Equal Opportunity Employer.
Qualified applicants are considered for employment without regard to race, color, age, national origin, religion, marital status, interaction, interactionual orientation, gender identity, gender expression, genetics, disability, protected veteran status or any other basis prohibited by law. We are committed to a diverse and inclusive workplace. Next Era Energy and provides reasonable accommodation in its application and selection process for qualified individuals, including accommodations related to compliance with conditional job offer requirements, consistent with federal, state, and local laws.
Supporting medical or religious documentation will be required where applicable and permitted by applicable law. To request a reasonable accommodation, please send an e-mail to , providing your name, telephone number and the best time for us to reach you. Alternatively, you may call -xyz X. Please do not use this line to inquire about your application status. Next Era Energy will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.
Next Era Energy does not accept any unsolicited resumes or referrals from any third-party recruiting firms or agencies. Please see our for more information. #LI-FB1 PDN-99de5da5-edc-0c3edf69d9f3
Mail/Calendar Soft Skill requirements (team fit/personality requirements) Exceptional Organizational Skills Able to Multi-task Strong Communication Skills Able to build and maintain strong working relationships1.
) Has the candidate applied or been interviewed for any role with this company in the past?
If so, please provide details. 2. ) Where is the candidate located? If candidate is not near the job location, please explain relocation plan in detail (e. g. timeline, relocating with family, selling/buying property) 3. ) What is the candidates desired total compensation? (Please specify base salary mission/bonus expectation) 4. ) Please provide the link to candidates Linked In
profile: 5. ) What is the candidates highest level of education? 6. ) What is the candidates work authorization status? 7. ) Is the candidate open and willing to travel upto 50% of time?
8. ) Please elaborate on the candidate's CAPPS programming knowledge and experience. Skills Intermediate Microsoft office skills Excel - Pivot Tables; Formulas Power Point - Able to edit or create Power Point Outlook Mail/Calendar Soft Skill requirements (team fit/personality requirements) Exceptional Organizational Skills Able to Multi-task Strong Communication Skills Able to build and maintain strong working relationships.
individuals who value opportunity, mentoring and a chance to stand out. We are looking to add Personal Lines Account Managers to our team! In this role, you will engage and service new and existing clients with our industry-leading client relationships management process.
The successful candidate will possess: 220 or 440 license Problem solving aptitude An interest in continuous learning Passion for client engagement Ability to analyze market trends and apply to the client relationship 3+ years previous inside PL account management experience Excellent verbal and written communication skills College degree preferred Proficiency in Microsoft Suite Knowledge of AMS360 a plus Bilingual English/Spanish
a plus As a Personal Lines Account Manager at SBIR, you will be joining a team who thrive on constant learning and enjoy the freedom to exercise personal initiative, while working collaboratively, when desired.
We provide the tools and knowledge necessary to deliver high quality solutions and positive results for clients. Your role on the team will include overseeing new and renewal business, managing the marketing and binding process, fielding coverage questions, responding to claims concerns, and identifying coverage opportunities. If you are looking for a company that provides you with a chance to stand out, stand up and grow, while working and playing hard, wed love to hear from you
-- Setnor Byer Insurance & Risk. What we offer Competitive compensation with bonus potential Generous medical, dental and vision package 401K with a rich company match Life Insurance Short-term disability Rich paid time-off Paid holidays Flex start times Continuing education assistance Catered Lunches Monthly Massages Charitable matching Pet adoption reimbursement On-site gym Plus extra surprise rewards
