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AmeriHealth Caritas Jobs
- 16,860 JobsInternal Communications Manager
Amerihealth Caritas
Amerihealth Caritas Job In Newtown, PA Or Remote
Your career starts now. We're looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at ************************** . **Job Summary** The Internal Communications Manager further establishes and strengthens the organization's strategic narrative and enhances employee engagement across the company. Working closely with the Director for Internal Communications, this individual partners with leadership and business partners to communicate key initiatives and programs. This position requires a creative mind, strategic thinking, excellent organizational skills, and the willingness to think unconventionally about employee engagement. **Essential Functions** - Explore, develop, and help drive communication strategies that creatively connect approximately 10,000 associates, leading to greater employee engagement in a diverse and hybrid work environment. - Establish greater opportunities for employee dialogue and cross-divisional information sharing using a variety of media. Help plan and develop internal-facing events, forums, and toolkits that increase transparency and promote a culture of collaboration. - Help to support a "newsroom" culture in which the stories and accomplishments of our colleagues are shared through digital communications and storytelling, in partnership with our creative services and brand team. - Work in partnership with the Director on leadership communication, making sure the unique insights and industry perspectives of our colleagues are shared across different channels and platforms. Additionally, maintain a consistent and compelling narrative that ties together our strategic priorities and long-term vision. - Monitor and measure communication effectiveness, adjusting strategies based on feedback and data. Maintain a team-wide dashboard that measures progress in a transparent manner for our business partners. - Implement, manage, and promote the adoption of new web-based tools and platforms that streamline operations and enhance internal processes. **Education/Experience** - Bachelor's Degree in related field preferred, or equivalent combination of education and experience. - 7 + years of communications experience in a fast-paced, deadline-driven environment. - Healthcare experience, specifically Medicaid or Medicare, is strongly preferred. - Understanding of the healthcare market and industry developments required. - Must be highly collegial, curious, and a great listener. Understands the value of team chemistry and thrives in a culture of collaboration with our Corporate Communication and Creative Services & Brand teams. This role requires flexibility and the willingness to think boldly. - Adept at building excellent working relationships across the organization, at all levels. Our role is to provide strategic communications counsel to our internal partners and colleagues. - Exceptional writing, editing, and verbal communication skills across all communication channels. Your portfolio demonstrates an ability to translate complex material under tight deadlines. - Ability to manage sensitive information with discretion and confidentiality. - Highly motivated with the ability to be flexible with priorities while managing multiple, deadline-oriented projects simultaneously. **NOTE:** AmeriHealth Caritas utilizes a hybrid work environment with associates working from home two days a week and in the office three days a week. The functions of this position will be performed onsite at our offices located at 3875 West Chester Pike, Newtown Square, 19073 **Diversity, Equity, and Inclusion** At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy. **Our Comprehensive Benefits Package** Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.$82k-99k yearly est. 25d agoCustomer Service Representative
Plymouth Rock Assurance
Woodbridge, NJ Job
Are you ready to embark on a rewarding career journey? At Plymouth Rock, we pride ourselves on fostering a dynamic and supportive service center environment where professionalism and teamwork are highly valued. If you're the kind of person who enjoys solving problems and helping others when they need it, this could be a great opportunity to start your career at Plymouth Rock! We're currently seeking passionate individuals to join our team as Customer Service Representatives, where you'll play a pivotal role in providing exceptional service to our valued customers, agents, and partners. As a Customer Service Representative, you'll be at the forefront of our customer interactions, handling inbound calls with efficiency and professionalism. RESPONSIBILITIES • Answer inquiries via phone, email and texting regarding policies, coverages, and premiums with confidence and accuracy. • Ensure first call resolution, making the customer experience as seamless as possible. • Develop and maintain comprehensive product knowledge across all three lines of insurance (Auto, Homeowner, and Umbrella). • Cultivate strong relationships with our agents and partners, contributing to our collaborative work environment. • Utilize your analytical and decision-making skills to address policy changes and corrections effectively. • Exceed customer and agent expectations by delivering top-notch service through positive interactions and extensive product expertise. • The ability to work a flexible schedule is a critical aspect of this position. Hours for this position are shifts between: 8:00am-7:00pm Monday - Friday and 10:00am-3:00pm every third Saturday. QUALIFICATIONS • Strong interpersonal, communication, and organizational skills. • Analytical mindset with good decision-making abilities. • Proficiency in computer skills and data entry. • High motivation to take ownership and follow up on tasks. • Flexibility to adapt to a fast-paced, changing environment. • Ability to work weekdays and rotational Saturdays. • High school diploma required, college degree is a plus! • Spanish language proficiency is a plus! SALARY RANGE The pay range for this position is $45,000 to $49,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. PERKS & BENEFITS • 4 weeks accrued paid time off + 9 paid national holidays per year • Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision) • Annual 401(k) Employer Contribution • Free onsite gym at our Woodbridge Location • Resources to promote Professional Development (LinkedIn Learning and licensure assistance) • Robust health and wellness program and fitness reimbursements • Various Paid Family leave options including Paid Parental Leave • Tuition Reimbursement ABOUT THE COMPANY The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.$45k-49.5k yearly 11d agoField Claims Representative
Auto-Owners Insurance
Frankenmuth, MI Job
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.$44k-57k yearly est. 2d agoSettlement Officer
Surety Title Company
Marlton, NJ Job
Summary of Functions: The role of the Settlement Officer is to assist the Closing Manager with settlements. Specific duties may include: prepare files for closing, ensure all items necessary to satisfy requirements are received, prepare the Closing Disclosure Form (CDF) according to lender and/or buyer/seller instructions, prepare affidavits, prepare necessary title company disclosures, balance and disburse the file, conduct closings ( or coordinate with signing agent ), audit the closed package and deliver to parties, confirm all payments are made, satisfy any post-closing issues, and any other duties assigned to him or her bythe Closing Manager. Essential Duties and Responsibilities: Maintains compliance with Surety Title Company, LLC policies and procedures in accordance with governing laws, regulations, regulatory agencies and company standards. Demonstrates on a consistent basis individual and team behavior that supports the culture of Surety Title Company, LLC. The essential duties and responsibilities of the Settlement Officer may include but are not limited to the following: • Establish and maintain positive internal and external customer relationships by providing exceptional customer service and professional communication. • Process residential settlements, generally involving purchase, cash, refinance, Equity Loans, Lot Closing, or new loan transactions. • Ensure that each settlement is properly completed and its contents filed in accordance with standardized procedures. Duties include but are not limited to: o Prepare Closing Disclosure Form, ALTA Settlement Statement or HUD-1 Settlement Statement for closing. o Obtain approval for Closing Disclosure Form, ALTA Settlement Statement or HUD-1 Settlement Statement from all parties. o Review and Prepare File for Closing, confirming all closing conditions are met. Including ensuring that all terms and conditions of the purchase and sale agreement are in compliance. o Perform the closing with all parties present, to include document notarization. o Process the accurate and timely disbursement of funds. o Prepare the documents for recording. o Ensure the timely deposit of funds collected. o Organize paperwork for delivery to lender and archiving. • Travel to requested settlement locations for closing. • Properly document notes in every file. • Properly scan all documents to file. • Ensure all outstanding checks are timely followed up and managed. • Ensure all escrowed funds are timely followed up and managed. • Assist with any department post-closing activities that maybe required. • Performs any other duties as requested. Supervisory Responsibilities This job has no supervisory responsibilities. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience • High School Diploma/GED required. • At least four years of HUD-1 and CDF Settlement Statement Preparation experience while working at a title company. • Experience Purchase, Reverse Mortgage, REO Closings (Deed in Lieu, Short Sales) preferred. • NJ Title License required. • Notary Public is required. Language Skills Ability to read, analyze, and interpret general business documents. Ability to write reports and business correspondence. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Computer Skills To perform this job successfully, an individual should have knowledge of Microsoft Office; a fax machine; a copier/scanning machine; and a multi-line telephone. Other Skills and Abilities • Ability to multi-task. • Ability to calculate payoffs, transfer taxes, mortgage taxes, etc. • High Standard of organization and attention to detail. • Ability to work under stress with time deadlines. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms and taste or smell. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision. Work Environment The 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. The noise level in the work environment is usually moderate.$58k-100k yearly est. 47d agoMaintenance Technician
Malone Workforce Solutions
Jefferson, OH Job
We are looking for a Maintenance Technician (HMI Programming) to join the team! This is a full-time, direct hire position that is 100% on-site in the Jefferson, OH area. This role includes performing preventative maintenance, mechanical repairs, and machine troubleshooting. A successful candidate is a self-motivated problem-solver that utilizes a strong work ethic to ensure all quality levels are met. The ideal candidate has a strong electrical and PLC manufacturing background and possesses the ability to read and understand ladder logic and program HMIs. Responsibilities: Complete mechanical repairs and makes adjustments as needed. Perform preventative maintenance on all machinery as assigned. Successfully troubleshoot mechanical problems. Complete welding and fabrication tasks with little direction. Accountable for entering data into maintenance system timely and accurately. Perform advanced electricity in order to work in maintenance field safely. Requirements: High school diploma or equivalent is required . Associate or bachelor's degree in a related field is a plus . Minimum 2 years of experience in maintenance with electrical and PLC skills is required . Advanced knowledge of electrical systems, hydraulics, pneumatics, and plumbing is required . Strong mechanical, welding, and cutting abilities are required . Ability to read and interpret mechanical, electrical, hydraulic, and pneumatic schematics is required . Hands-on experience with meters and measurements is required. Must pass an electrical board and PLC programming assessment. Training in CPR, first aid, lockout/tagout, fall protection, PPE, and confined spaces may be required. Basic English proficiency is required to read safety instructions, understand work orders, and communicate with supervisors and coworkers. Ability to follow verbal and written instructions in English. Details: This is a full-time, direct hire position that is 100% on-site in the Jefferson, OH area. Schedule: We are hiring for 2nd or 3rd shift. Pay: $30-40/hr. (based on experience) +$1,500 sign-on bonus + Profit Sharing. $1.50/hr. shift differential for 2nd and 3rd shifts. Low-cost comprehensive medical benefits package on day one ! Overtime is paid at time-and-a-half and double-time starts after 48 hours. This is a W-2 position. No B2C/C2C. No sponsorship. Malone is an Equal Opportunity Employer.$30-40 hourly 6d agoNurse Practitioner
Allied Digestive Health
Newark, NJ Job
About the Role: Welcome to Allied Digestive Health! We are seeking a Full Time (FT) Nurse Practitioner (NP) to join our Family at Gastroenterology Medical associates in Jersey City, NJ. As a Nurse Practitioner, you will play a crucial role in delivering high-quality healthcare services to patients across various age groups. Your primary responsibility will be to conduct comprehensive clinical assessments, develop treatment plans, and provide ongoing management of patient care in family medicine, geriatrics, and pediatrics. You will collaborate with a multidisciplinary team to ensure patient safety and effective pain management, addressing both acute and chronic health issues. This position requires a strong commitment to patient education and advocacy, empowering individuals to make informed health decisions. Ultimately, your expertise will contribute to improved health outcomes and enhanced quality of life for the patients you serve. Minimum Qualifications: Master's degree in Nursing with a specialization as a Nurse Practitioner. Current Nurse Practitioner license and certification in Family Medicine or a related field. At least 2 years of clinical experience in a healthcare setting. This is a Outpatient role. Monday through Friday, no nights or weekends. Preferred Qualifications: Experience in pain management and trauma care. Certification in geriatrics or pediatrics. Bilingual skills to communicate effectively with diverse patient populations. Responsibilities: Conduct thorough clinical assessments and evaluations of patients to determine their healthcare needs. Develop and implement individualized treatment plans based on evidence-based practices. Monitor patient progress and adjust treatment plans as necessary to ensure optimal health outcomes. Educate patients and their families on health management, preventive care, and lifestyle modifications. Collaborate with physicians, nurses, and other healthcare professionals to provide comprehensive care. Skills: The required skills of clinical assessments and patient safety are essential for accurately diagnosing and managing patient conditions on a daily basis. Your expertise in family medicine will guide your interactions with patients, allowing you to provide tailored care that meets their unique needs. Skills in pain management will enable you to address complex pain issues, ensuring that patients receive appropriate relief and support. Additionally, your knowledge of geriatrics and pediatrics will enhance your ability to care for patients across the lifespan, fostering a holistic approach to health. Preferred skills, such as bilingual communication, will further enrich your interactions with patients, promoting inclusivity and understanding in healthcare delivery. Key Benefits: Our Benefits Package Includes (but is not limited to) Competitive annual base salary Medical, Dental, Vision, Life Insurance, Disability Malpractice Occurrences- Based CME Allowance Paid Time off (PTO) CME Days Licensure reimbursement 401K with a 3% safe harbor contribution About us: Our office is located in Jersey City, NJ. Minutes by train to the exciting city of Manhattan, NY. A short car ride to the Jersey Shore beaches, where boating, sailing, fishing and whale watching ate great ways to enjoy the stunning state of NJ. Great schools, neighborhoods, stores and restaurants, Union County, NJ has it all! To learn more about this practice, click the link below: ********************************$82k-149k yearly est. 26d agoAppeals and Grievances Medical Director - Cardiology Required - Remote
Unitedhealthcare
Remote or Tampa, FL Job
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies Perform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results Provide clinical and strategic input when participating in organizational committees, projects, and task forces You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: MD or DO with an active, unrestricted license Board Certified Cardiologist in an ABMS or AOBMS specialty 5+ years clinical practice experience 2+ years Quality Management experience Intermediate or higher level of proficiency with managed care Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills Proven excellent telephonic communication skills; excellent interpersonal communication skills Proven excellent project management skills Proven data analysis and interpretation skills Proven excellent presentation skills for both clinical and non-clinical audiences. Familiarity with current medical issues and practices Proven creative problem-solving skills Proven solid team player and team building skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $269,500 to $425,500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.$269.5k-425.5k yearly 1d agoResidential Title Examiner
Chicago Title Insurance Company
Remote or Waukesha, WI Job
Chicago Title is seeking a dedicated and experienced Residential Title Servicing Examiner to join our team, with the option to work remotely or in the office. (Training in office may be required). In this role, you will be responsible for reviewing search reports, preparing preliminary commitments and updating/servicing commitments. Individual must have great communication skills, ability to work effectively with others and independently and be able to multi-task in a fast paced and service focused environment.$30k-42k yearly est. 6d agoClaims Trainee, Property Damage
Plymouth Rock Assurance
Woodbridge, NJ Job
This individual is responsible for the handling of Auto Property Claims in accordance with NJ Unfair Practices Act. The environment is fast paced with heavy phone work. The position requires patience and the ability to function professionally in adversarial situations. RESPONSIBILITIES Investigate and interpret policy provisions, endorsements and conditions to make a coverage determination in the automobile property claim. Identify and investigate Contested Coverage Claims with recommendation prepared for coverage committee. Responsible for the investigation of the auto accident to make a liability assessment. This includes interviewing first and third party claimants, witnesses, investigating officers and other relevant parties, along with securing pertinent records, documentation and loss scene information. Analyze the investigation to determine proximate cause, negligence, and damages. Evaluate and adjust reserves as necessary. Prepare dispatch instructions for field personnel to inspect vehicles. Negotiate and settle claims within his/her individual authority. Submit claims for approval to supervisor when over his/her authority or for guidance, review and/or referral when appropriate. Maintain an effective follow-up system on pending files. Prioritize and handle multiple tasks simultaneously. Adjust to fluctuating workload. Advise insureds, claimants, brokers on the status of the claim. Act as an intermediary between the Company, preferred vendors and customers. Resolve all disputes that may arise. Ensure that service, loss and expense control are maintained at all times. Adhere to privacy guidelines, law and regulations pertaining to claims handling. Investigate and initiate subrogation when applicable. Handle and respond to arbitration and special civil part lawsuits pertaining to property damage. Participate in catastrophic claim handling as requested/needed. This may include traveling to other locations and extended hours. Other duties as assigned. QUALIFICATIONS Strong customer service, organizational, verbal, and written skills are required. Basic personal computer skills including working knowledge of Microsoft Office Suite products. Bachelor's Degree from a four-year college or university required and/or 2-4 years of relevant work experience. Recent college graduates are encouraged to apply! SALARY RANGE The pay range for this position is $47,000 to $55,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. PERKS & BENEFITS 4 weeks accrued paid time off + 9 paid national holidays per year Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision) Annual 401(k) Employer Contribution Free onsite gym at our Woodbridge Location Resources to promote Professional Development (LinkedIn Learning and licensure assistance) Robust health and wellness program and fitness reimbursements Various Paid Family leave options including Paid Parental Leave Tuition Reimbursement ABOUT THE COMPANY The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.$47k-55k yearly 9d agoCommercial Lines Insurance Processor
Seltzer Group Partners
Orwigsburg, PA Job
About Us Founded in 1948, Seltzer Group Partners offers businesses and people the best insurance programs available, delivers superior risk-management solutions and provides exceptional thought leadership. Our mission is to change the way our clients view insurance and manage risk. This enables us to deliver the highest-quality coverage that protects what they value most. Today, Seltzer Group Partners works with individuals and businesses in 11 different locations in eastern Pennsylvania, including Orwigsburg, Pottsville, Emmaus, Reading, Myerstown, Mount Penn, White Haven, Reading, Honey Brook, Lansford and Bethlehem. We also serve customers in Bradenton, FL. Seltzer Group Partners provides a team of people to help our clients with a wide range of specialized services. Every client is assigned a Client Advocate to quarterback and champion our client's specific business needs across our portfolio of different services. Each service area, whether it's business insurance, workers' compensation management, disaster recovery, safety, personal insurance or human resources management, has its own practice leader who also works directly with clients on those specific issues. Commercial Lines Insurance Processor Position Summary: The Commercial Lines Insurance Processor role will provide support to several aspects of commercial account servicing while adhering to agency procedures and standards as well as Seltzer core values. Responsibilities: Answer and direct phone calls appropriately. Receive and return calls in a timely, courteous manner, providing customer service experience effectively and efficiently. Assist customers with billing inquiries, payments, proof of insurance, mortgagee changes. Correspond with the insured and companies to obtain information or inform them of their account status or changes. Enter data into computer for use in managing accounts. Update our agency management system with manual renewals. Document and follow-up on all cancellation non-payment notifications. Document each interaction with a customer in our agency management system and attach emails and documents in accordance with agency procedures. Develop and maintain relationships with clients to retain business. Understand the limits of insurance coverage interactions with clients. Maintain a courteous and effective relationship with clients, co-workers, insurance carriers, business contacts and represent the agency in an ethical and professional manner. Maintain confidentiality of company and client information. Any other duties, responsibilities or activities as assigned. Qualifications: High School Diploma required Minimum of 1 year of related customer service experience; commercial lines insurance experience desired Active Pennsylvania Property and Casualty License preferred or the willingness to obtain the license within 12 months of date of hire Proficiency with Microsoft Office Suite (Word, Excel, Outlook) Experience with an agency management system, preferably Applied Epic Ability to learn and use individual company software and programs to service accounts Knowledge of processes for providing customer service Must display a positive attitude at all times Strong oral and written communication skills Ability to listen and speak effectively to others Ability to manage one's own time Ability to organize, plan and prioritize workload Ability to take direction and work both independently and as part of a team Hours: Monday-Friday, 8:30am-5:00pm Office Location: 609 Route 61 South, Orwigsburg, PA 17961 Benefits: Competitive Compensation Health Insurance Plans (PPO, HSA, Copay Options) Dental Insurance Vision Insurance Company Paid Disability Insurance Supplemental Insurance including Critical Illness, Accident, Legal, Pet Insurance 401(k) with Safe Harbor Match Paid Time Off Paid Holidays No Solicitation Notification to Agencies: Please note that Keystone Agency Partners and our Partner Agencies do not accept unsolicited resumes or calls from third-party recruiters or employment agencies. In the absence of a signed Master Service Agreement and approval from HR to submit resumes for a specific requisition, Keystone Agency Partners will not consider or approve payment to any third parties for hires made.$32k-38k yearly est. 32d agoRegistered Nurse
Allied Digestive Health
Somerset, NJ Job
Allied Digestive Health is one of the largest integrated networks of gastroenterology care centers in the nation with over 200 providers and 60 locations throughout New Jersey and New York. As a fast-growing physician-led organization, our dynamic structure encourages physician input and decision-making, while simultaneously offering operational support. Our dedicated, compassionate team of providers prioritize personalized treatment plans for patients that deliver the highest quality of care. All of our doctors are board-certified in gastroenterology and hepatology. Several of them serve as chief of gastroenterology at nearby hospitals, and a number of them have been recognized as top-quality physicians in publications, including but not limited to: Best Doctors in America and Top Doctors New Jersey, and US News Health - US News & World Report. Click here to learn more about Allied Digestive Health: ********************************** We are excited to announce that we are looking for a Full-Time Registered Nurse(RN) at our Gastroenterology Group of Northern New Jersey office in Englewood Cliffs NJ The Registered Nurse (RN) responsibilities are: Assisting in the delivery of healthcare and patient care management Restores and promotes patient's health by completing the nursing process. Collaborates with physicians and multidisciplinary team members. Identifies patient care requirements by establishing personal rapport with patients and their families. Assures quality of care by adhering to therapeutic standards; measuring health outcomes against patient care goals and hospital or regulatory standards. Resolves patient problems and needs by utilizing multidisciplinary team strategies. Requirement: NJ RN License in good standing At least 2 years of experience as an RN Must have supervisory experience. This role will require supervision of our Medical Assistant (MA) team Administrative experience a must Excellent communication and computer skills Key Benefits: Health Benefits Day 1 including major medical, dental, vision, prescription, life insurance and disability. Competitive base salary 401K with 3% safe harbor contribution Licensure reimbursement Paid Time off Excellent quality of life balance! About the community: Englewood Cliffs is located in Bergen county, NJ. Located minutes from the exciting city of Manhattan, NY. Stately homes located in some of the most beautiful neighborhoods. Great schools, restaurants, and stores. A great place to raise a family!$67k-142k yearly est. 17d agoCommercial Lines Claims Processor
Seltzer Group Partners
Orwigsburg, PA Job
About Us Founded in 1948, Seltzer Group Partners offers businesses and people the best insurance programs available, delivers superior risk-management solutions and provides exceptional thought leadership. Our mission is to change the way our clients view insurance and manage risk. This enables us to deliver the highest-quality coverage that protects what they value most. Today, Seltzer Group Partners works with individuals and businesses in 11 different locations in eastern Pennsylvania, including Orwigsburg, Pottsville, Emmaus, Reading, Myerstown, Mount Penn, White Haven, Reading, Honey Brook, Lansford and Bethlehem. We also serve customers in Bradenton, FL. Seltzer Group Partners provides a team of people to help our clients with a wide range of specialized services. Every client is assigned a Client Advocate to quarterback and champion our client's specific business needs across our portfolio of different services. Each service area, whether it's business insurance, workers' compensation management, disaster recovery, safety, personal insurance or human resources management, has its own practice leader who also works directly with clients on those specific issues. Commercial Lines Claims Processor Position Summary: The Commercial Lines Claims Processor will provide support to several aspects of commercial account servicing while adhering to agency procedures and standards as well as Seltzer core values. Responsibilities: Answer and direct phone calls appropriately. Intake new claims reported by clients and team members. Submit claims to carriers on behalf of the insured, per agency procedures. Follow up with carriers for claims numbers, adjuster assignments, and status updates. Provide support to the Claims Manager and team on special projects or urgent needs. Any other duties, responsibilities or activities as assigned. Qualifications: High School diploma required Minimum of 1 year of related experience within the insurance industry desired Active Pennsylvania Property & Casualty license, or the willingness to obtain the license within 12 months of date of hire Proficiency with Microsoft Office Suite Experience with an agency management system, preferably Applied Epic Ability to learn and use individual company software and programs to service accounts Ability to work in a fast-paced office environment with significant telephone and interoffice activity Basic knowledge of processes for providing customer service Strong oral and written communication skills; ability to listen and speak effectively to others Ability to take direction and work both independently and as part of a team Ability to manage one's own time; organize, plan, and prioritize workload Hours: Monday-Friday, 8:30am-5:00pm Office Location: 609 Route 61 South, Orwigsburg, PA 17961 Benefits: Competitive Compensation Health Insurance Plans (PPO, HSA, Copay Options) Dental Insurance Vision Insurance Company Paid Disability Insurance Supplemental Insurance including Critical Illness, Accident, Legal, Pet Insurance 401(k) with Safe Harbor Match Paid Time Off Paid Holidays No Solicitation Notification to Agencies: Please note that Keystone Agency Partners and our Partner Agencies do not accept unsolicited resumes or calls from third-party recruiters or employment agencies. In the absence of a signed Master Service Agreement and approval from HR to submit resumes for a specific requisition, Keystone Agency Partners will not consider or approve payment to any third parties for hires made.$40k-57k yearly est. 32d agoLicensed Practical Nurse
Allied Digestive Health
Trenton, NJ Job
Welcome to Hamilton Gastroenterology Group! We are seeking a Full Time (FT) Licensed Practical Nurse(LPN) to join our team. To learn more about this practice click the link below: *********************** The Licensed Practical Nurse (LPN) must have the following qualifications and experience: Requirements: Conducting nursing interviews to determine medical eligibility for screening colonoscopy/endoscopy. This process includes collecting medical and family histories from patients, reviewing preps and scheduling procedures or office visits. Managing the patient throughout our Capsule Endoscopy procedure process; includes obtaining and reviewing patient medical history, providing prep instructions, placement and removal of Capsule Endoscopy equipment, guidance to patient during procedure process. Place and remove equipment for Capsule Endoscopies Providing high quality patient care in an office setting is require Current NJ LPN License Minimum of one years of experience in a clinical role Excellent computer skills Must demonstrate knowledge and skills to provide appropriate care to all age groups Key Benefits: Competitive hourly rate Health Benefits Day One including Medical, Dental, Vision Life Insurance Prescription and Disability Voluntary Time off Benefits 401K with 3% safe harbor contribution Employee Assistance Program Commuter Benefits Hamilton Gastroenterology Group have partnered with Allied Digestive Health which is one of the largest integrated networks of gastroenterology care centers in the nation with over 200 providers and 60 locations throughout New Jersey and New York. As a fast-growing physician-led organization, our dynamic structure encourages physician input and decision-making, while simultaneously offering operational support. Our dedicated, compassionate team of providers prioritize personalized treatment plans for patients that deliver the highest quality of care. All of our doctors are board-certified in gastroenterology and hepatology. Several of them serve as chief of gastroenterology at nearby hospitals, and a number of them have been recognized as top-quality physicians in publications, including but not limited to: Best Doctors in America and Top Doctors New Jersey, and US News Health - US News & World Report. Located in stunning Mercer County, NJ located close to great schools such as Princeton and Rutgers. Beautiful farm like settings, great neighborhoods, schools, ad restaurants! Mercer County has it al!$48k-69k yearly est. 5d agoSocial Worker, Care Coordinator
Viva Health
Remote or Birmingham, AL Job
Social Workers! VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is currently seeking a SW, Care Coordinator in Birmingham, AL! VIVA HEALTH knows that social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! Care Coordinators use psychosocial and/or clinical knowledge to provide non-clinical services for Medicaid recipients to improve the medical compliance and health outcomes of the populations served. This position identifies barriers to medical compliance such as lack of transportation, illiteracy, or other social determinants that impact a member's health, and ensures services are delivered and continuity of care is maintained. The position analyzes the home and community environment and makes autonomous decisions regarding appropriate care plans and goals using a thorough knowledge of available community resources. These services are provided primarily in community and home settings via phone and/or in person. Local daytime travel is required via a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities. GENERAL CARE COORDINATION One of the following is Required: Licensed BSW Preferred: Licensed Master of Social Work (LMSW) designation and/or Certified Case Manager (CCM) designation Experience in case management, human services, public health, or experience with the underinsured population Also requires a valid driver's license in good standing, willingness to submit to vaccine testing and screening, and may require significant face-to-face member contact with duties performed away from the principal place of business. All positions require excellent interview and telephone skills as well as the ability to deal with recipients in a caring and helpful manner. The Care Coordinators should have a working knowledge of health-related service delivery systems and excellent communication and relationship skills. This position requires the ability to analyze varied environmental factors to members' well-being and work independently in an autonomous setting and the ability to locate, augment, and develop resources, including information on services offered by other agencies.$42k-51k yearly est. 60d+ agoLTSS Service Care Manager - Behavioral Health
Sunflower Health Plan
Remote or Wichita, KS Job
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. **Applicants for this role must live in Reno or Sedgwick county as the position requires approximately 50% local travel to visit members in that area. Candidates are able to work remotely from their home the remaining time.** Position Purpose: Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes. Evaluates member service needs and develops or contributes to development of care plans/service plans, and educates members, their families and caregivers on services and benefits available to meet member needs. Evaluates the needs of the most complex and high risk members with mental/behavioral health needs, and recommends a plan of care for the best outcome Acts as liaison and member advocate between the member/family, physician, and facilities/agencies Supports members with primarily mental/behavioral health needs, such as those with (or a history of) major depression, bipolar disorders, schizophrenia, borderline personality disorder, post-traumatic stress disorder, substance use disorder, self-injurious behavior, psychiatric inpatient admissions, etc Performs frequent home and/or other site visits (once a month or more), such as to assess member needs and collaborate with resources, as required Provides and/or facilitates education to long-term care members and their families/caregivers on topics such as preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication treatment regimens, and healthcare benefits. Provides subject matter expertise and operational support for relevant mental and behavioral health-focused activities, such as the handling of crisis calls, mental health first aid training, field safety and de-escalation practices, psychotropic and other medication monitoring, etc Educates on and coordinates community resources, to include medical, behavioral and social services. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living) Ensures appropriate referrals based on individual member needs and supports the identification of providers, specialists, and community resources. Ensures identified services are accessible to members Maintains accurate documentation and supports the integrity of care management activities in the electronic care management system. Works to ensure compliance with clinical guidelines as well as current state and federal guidelines Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires a Master's degree in Mental Health or Social Work or Graduate from an Accredited School of Nursing and 2 - 4 years of related experience. License/Certification: Licensed Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMFT, LMHC, LPC and RN with BH experience required required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act$26.5-47.6 hourly 1d agoCommunity Health Worker
Viva Health
Remote or Birmingham, AL Job
VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, has an opportunity for a Community Health Worker in Birmingham, AL! VIVA HEALTH's employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! We offer a great benefits package including 401k, tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! The Community Health Worker will work alongside the Alabama Coordinated Health Networks (ACHN) and/or Medicare teams to ensure that recipients have access to all covered services appropriate to the recipient's condition or circumstance. This role will assist Care Coordinators and Care Managers in carrying out care management services by providing assistance with promoting disease self-management, utilizing approved education tools, providing information to the patient on medical and community services as directed, and assisting with carrying out established plan of care as directed. This individual may also assist with Health Risk Assessments and referral generation. This position will travel to locations within the relevant service area through a reliable means of transportation insured in accordance with Company policy. This position will have work from home opportunities. REQUIRED: High School Diploma or GED One year of experience in a call center or healthcare related field College graduate or currently enrolled in college may be considered in lieu of experience Valid driver's license in good standing May require significant face-to-face contact with duties regularly performed away from the principal place of business Willing to submit to vaccine testing and screening Good interview and telephone skills as well as the ability to deal with recipients in a caring and helpful (assertive and tactful) manner Ability to understand health-related service delivery systems Excellent communication and relationship skills Ability to analyze varied environmental factors in relation to recipients' well being Organization and Time Management skills Ability to be flexible, adaptable, and work effectively in a variety of settings, especially in the community Basic computer skills PREFERRED: Bachelor's degree Experience in case management, human services, public health, or experience with the underinsured population Ability to utilize Microsoft Word and Excel$31k-38k yearly est. 5d agoSenior Bodily Injury Claims Examiner
King's Insurance Staffing
Remote Job
Our client, a leading insurance carrier, is looking to hire a Commercial Bodily Injury Claims Examiner to their New England team. This crucial role involves managing complex claims in both bodily injury and casualty, ensuring accurate, fair, and legally compliant resolutions. The ideal candidate will bring a strong background in insurance carrier operations, with extensive experience in claims evaluation and settlement negotiations. Key Responsibilities: Investigate and evaluate Commercial Liability and Bodily Injury claims to determine liability and estimate damages. Negotiate settlements and manage litigation efficiently, ensuring timely and equitable outcomes. Analyze detailed information, including medical records, accident reports, and legal statements to assess claims accurately. Advise on coverage issues and contribute to the development of claims handling policies. Mentor junior adjusters and provide expert guidance on complex claims scenarios. Maintain comprehensive records of all claim activities, ensuring all documentation is accurate and up-to-date in the claims management system. Ensure compliance with all regulatory and internal guidelines during the claims process. Requirements: 5+ years of experience handling Commercial or Personal Lines Bodily Injury claims. Experience working for an insurance carrier is preferred. Active adjuster license is a plus. Strong negotiation skills with a proven track record of resolving claims effectively. Exceptional analytical and problem-solving abilities. Proficiency in claims management software and Microsoft Office. Bachelor's degree highly preferred. Salary & Benefits: $80,000 to $110,000+ annual base salary plus Bonus Generous PTO Opportunity to work remotely. Competitive 401k Employer Matching Contributions Comprehensive benefits package including health, dental, and vision coverage. Opportunities for advancement and professional growth. Supportive and inclusive team environment.$37k-48k yearly est. 41d agoHuman Resources Specialist
Viva Health
Remote or Birmingham, AL Job
Human Resources (HR) Specialist Work Schedule: Hybrid schedule with regular work onsite at the VIVA HEALTH corporate office and some work-from-home opportunities. Why VIVA HEALTH? VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare. Benefits Comprehensive Health, Vision, and Dental Coverage 401(k) Savings Plan with company match and immediate vesting Paid Time Off (PTO) 9 Paid Holidays annually plus a Floating Holiday to use as you choose Tuition Assistance Flexible Spending Accounts Healthcare Reimbursement Account Paid Parental Leave Community Service Time Off Life Insurance and Disability Coverage Employee Wellness Program Training and Development Programs to develop new skills and reach career goals Employee Assistance Program See more about the benefits of working at Viva Health - ******************************************* The Human Resources Specialist is primarily responsible for assisting the Human Resources (HR) department with administrative processes related to the areas of records, HR Information System (HRIS), and compensation while providing excellent customer service and support. This position will also serve as backup to the Company's Payroll and Benefits functions and the HR reception desk. Key Responsibilities Maintain Company's HR applicable employee records and files, including paper and electronic records. Enter and update information, audit data for accuracy, and prepare routine and ad hoc reports within the HRIS system. Serve as primary backup for payroll processing, including but not limited to daily payroll operations, accurate and timely payroll preparation and processing, routine and ad hoc reporting, and subsequent accounting, billing, and reconciliation. Support the administration of all employee benefits including health and welfare benefits, 401(k), and ancillary programs. Maintain processes, procedures, materials, and communications to support all benefit program administration. Help coordinate, monitor, and track employee enrollment. Support the administration and maintenance of the organization's compensation program including Job Descriptions, Job Classification, and Position Management. Assist in administering leave management and worker's compensation processes and procedures. Serve as a point of contact and subject matter expert for functional areas. Respond accurately to questions in a timely manner. Troubleshoot issues and escalate when necessary. REQUIRED QUALIFICATIONS: Bachelor's Degree or equivalent work experience Ability to deliver work that demonstrates attention to detail, accuracy, thoroughness, and efficiency Ability to work in a fast-paced, demanding environment managing sensitive and confidential information Ability to manage multiple tasks simultaneously with frequent interruptions and minimal supervision while producing quality work within limited delivery timelines; Ability to adapt to frequently changing work priorities Customer service oriented with a proven track record of responding to employees quickly and thoroughly with accurate and complete follow-through to ensure a final resolution Ability to read, analyze, and interpret general business periodicals, professional journals, and government regulations Ability to apply critical thinking skills to aid in data analysis, evaluation of information, and problem solving Ability to exercise confidentiality, discretion, diplomacy, and professional poise and appearance Proficient in the Microsoft Office suite of products with strong proficiency in Microsoft Excel; Ability to quickly learn and develop proficiency with other software packages Excellent written and oral communication skills including the ability to effectively present information and respond to questions from individuals and groups PREFERRED QUALIFICATIONS: Bachelor's degree in business administration, human resources, or accounting 1 - 3 years' experience working in benefits or payroll Basic comprehension of HR and payroll practices, policies, and procedures$39k-51k yearly est. 17d agoClaims Trainee, Property Damage
Plymouth Rock Assurance
Fort Washington, PA Job
This individual is responsible for the handling of Auto Property Claims in accordance with NJ Unfair Practices Act. The environment is fast paced with heavy phone work. The position requires patience and the ability to function professionally in adversarial situations. RESPONSIBILITIES Investigate and interpret policy provisions, endorsements and conditions to make a coverage determination in the automobile property claim. Identify and investigate Contested Coverage Claims with recommendation prepared for coverage committee. Responsible for the investigation of the auto accident to make a liability assessment. This includes interviewing first and third party claimants, witnesses, investigating officers and other relevant parties, along with securing pertinent records, documentation and loss scene information. Analyze the investigation to determine proximate cause, negligence, and damages. Evaluate and adjust reserves as necessary. Prepare dispatch instructions for field personnel to inspect vehicles. Negotiate and settle claims within his/her individual authority. Submit claims for approval to supervisor when over his/her authority or for guidance, review and/or referral when appropriate. Maintain an effective follow-up system on pending files. Prioritize and handle multiple tasks simultaneously. Adjust to fluctuating workload. Advise insureds, claimants, brokers on the status of the claim. Act as an intermediary between the Company, preferred vendors and customers. Resolve all disputes that may arise. Ensure that service, loss and expense control are maintained at all times. Adhere to privacy guidelines, law and regulations pertaining to claims handling. Investigate and initiate subrogation when applicable. Handle and respond to arbitration and special civil part lawsuits pertaining to property damage. Participate in catastrophic claim handling as requested/needed. This may include traveling to other locations and extended hours. Other duties as assigned. QUALIFICATIONS Strong customer service, organizational, verbal, and written skills are required. Basic personal computer skills including working knowledge of Microsoft Office Suite products. Bachelor's Degree from a four-year college or university required and/or 2-4 years of relevant work experience. Recent college graduates are encouraged to apply! SALARY RANGE The pay range for this position is $45,000 to $52,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. PERKS & BENEFITS 4 weeks accrued paid time off + 9 paid national holidays per year Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision) Annual 401(k) Employer Contribution Resources to promote Professional Development (LinkedIn Learning and licensure assistance) Robust health and wellness program and fitness reimbursements Various Paid Family leave options including Paid Parental Leave Tuition Reimbursement ABOUT THE COMPANY The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.$45k-52.5k yearly 9d agoBehavioral Health Utilization Management Reviewer
Amerihealth Caritas
Remote Amerihealth Caritas Job
Your career starts now. We're looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at *************************** **Responsibilities:** Under the direction of the Supervisor, the BH UM Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the clinician reviews provider requests for inpatient and outpatient services, working closely with providers to collect all information necessary to perform a thorough medical necessity review. It is within the BH UM Reviewer's discretion to retain requests for additional information and/or request clarification. The BH UM Reviewer will use his/her professional judgment to evaluate the request to ensure that appropriate services are being requested and refer those cases to integrated care management as needed. The BH UM Reviewer will apply the appropriate medical necessity criteria to authorize services and appropriately identify and refer requests to the Medical Director when indicated. The BH UM Reviewers are responsible for ensuring that the treatment delivered is appropriately utilized and meets the member's needs in the least restrictive, least intrusive manner possible. The BH UM Reviewer will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application. **Education/Experience:** This position requires the ability to work Monday-Friday, 40 hours/week, during Eastern Standard Time. Candidates must be willing to work up to four holidays each year, to include rotating between Thanksgiving Day and Christmas Day observed. Candidates must be willing to work 1-2 weekends per year. · **Current active professional licensure/independent licensed required** : LPC, LCSW, LISW, LICSW, LCMHC, LMHC, LMFT or RN (Registered Nurse graduate from an accredited institution with an Associate Degree or Bachelor's Degree; compact state licensure). · Two or more years of behavioral health experience and substance use disorder experience required. · Utilization management experience preferred. · MCO (Managed Care Organization) experience preferred. · Proficiency in Microsoft Office, including Word, Excel and Outlook is required. Consistent word processing speed and accuracy of 50 or more words per minute. · Ability to communicate in a positive/professional manner both orally and written. · Ability to follow detailed instructions with a high degree of accuracy. · Ability to work independently; complete tasks in the allotted time frame. · Strong problem-solving skills and decision-making skills required. · Experience working in a remote work environment preferred. · Strong organizational and time management skills required. · Ability to obtain additional licensure based on business need to include: Louisiana, District of Columbia, Ohio, and North Carolina. **Diversity, Equity, and Inclusion** At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy. **Our Comprehensive Benefits Package** Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.$45k-71k yearly est. 3d ago
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AmeriHealth Caritas may also be known as or be related to AmeriHealth Caritas, Amerihealth Caritas and Amerihealth Caritas Health Plan.