Sales representative for UHC Key Accounts is responsible for broker and direct sales to customers in the 100 5,000 employee range. The principle focus is the sale of new fully insured business, ASO business (both TPA and bundled) with indirect responsibility for the retention of existing accounts New Business Sales Accountable for prospect from presale to implementation w

Perform capacity planning and reporting Claims related and business system analysis Responsible for all aspects of quality assurance Create and edit requirements, specifications, cost benefit analysis and recommendations to proposed solutions Facilitate development of process documentation Solves unique and complex problems with broad impact on the business Participates i

Develop innovative and compelling collateral to engage target audience (i.e. state reviewers and key stakeholders) Take complex scenarios, strategies and/or issues and simplify them into easy to understand visuals that resonate with the target audience Create designs that push the expected creative boundaries while maintaining brand and bid compliance Work with Proposal C

Effectively and efficiently handle 4.5 hours/per day of incoming calls from People Team, Managers, and 'One Breath' cases Complete intake for all Employee Relations case types to either manage/escalate appropriately to Sr. Employee Relations Analysts and ER Case Managers Manage own caseload, providing coaching and consultation to managers on issues involving non exempt em

Make outbound calls and receive inbound calls to assess members' current health status Make referrals to outside sources Identify gaps or barriers in treatment plans Provide patient education to assist with self management Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condit

Assist in end to end provider claims and help enhance call quality Coach, provide feedback and guide others Assist in efforts to enhance ease of use of physician portal and future services enhancements Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers Help implement traini

Set strategy for experience improvement that supports FP member NPS and retention goals Establish a culture focused on our people obsessed with continual improvements to our members' experience Present strategy to senior management and measure against the strategy Identify, develop, and support the implementation of operational process changes & innovative solutions that

Perform utilization review determinations for radiation oncology populations, and support case and disease management teams to achieve optimal clinical outcomes Speak with providers by phone. This will include discussion of evidence based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expense Enhance c

Collect pertinent patient data (e.g., vital signs; complaints; medications and allergies; health screening information) in order to identify care needs Provide relevant medical services/care as directed by physicians (e.g., injections; procedures; treatments) Support and/or coordinate safe transportation of patients to and from medical appointments/facilities (e.g., drive

Execute the build and implementation of benefit plan adjudication rules Coordinate the integration or conversion of new clients and / or products as needed, often under aggressive timelines Participate in the development and implementation of an enterprise claim platform, providing subject matter expertise on the system configuration and usability components Align operati

Make calls to qualified members to provide information and answer questions about health plan programs. Provide "best in class" customer service to enrollees. Meet established productivity, schedule adherence, and quality standards while maintaining good attendance. Identify, qualify, and engage members into the most appropriate health and wellness programs to meet their

Manage administrative intake of members Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review

Oversee initial inpatient admission requests for psychiatric and chemical dependency patients Make patient assessments and determine appropriate levels of care Administer benefits, review treatment plans, and coordinate transitions between various areas of care Obtain information from providers on outpatient requests for treatment Provide utilization management concurrent

Make outbound calls and receive inbound calls to assess members' current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condit

Designs, develops, tests, documents and maintains database queries and reports Works with customers to define and document additional requirements and efficiency innovations to enrich reporting capabilities Develops systematic reporting processes and procedures to ensure timely delivery of daily, weekly, monthly, annual and ad hoc reporting to management Troubleshoots dat