Health Care Service Corporation

Recruitment

• Provides strategic leadership for HCSC's early careers ecosystem
• Oversees the execution and continuous improvement of internship, new graduate and emerging talent programs
• Leads a team responsible for delivering enterprise-wide early careers initiatives
• Collaborates with business leaders and HR partners to build sustainable talent pipelines aligned with organizational workforce needs
• Serves as a key ambassador for HCSC's employer brand
• Drives innovative talent attraction and development strategies that position HCSC as an employer of choice for emerging talent

Manager, Talent Acquisition – Early Careers

Pharmacist

• Performing Activities Associated With Administration And Management Of Pharmacy Programs Including But Not Limited To Assisting In The Development, Implementation And Maintenance Of A Disease State Formulary System.
• Utilization Management Programs.
• Specialty Pharmacy Management.
• Medication Therapy Management, Client Relationships And Support; And Development Of Innovative Clinical Programs.

Clinical Account Consultant, Pharmacy

Claims Specialist

• Responsible for programming and implementing Enterprise claims auditing logic under the direction of the Manager Professional Reimbursement Programs
• Assists in the implementation, updates, and maintenance of code auditing software.

Claims Reimbursement Analyst

Manager

• Manage health care fraud and internal fraud investigations
• Manage and train investigators and support staff
• Establish and maintain liaison with health care providers and law enforcement
• Coordinate anti-fraud activities with other departments at HCSC
• Partner with Compliance, Legal, Audit, Provider Services, Clinical Operations, and external regulatory agencies to detect, investigate, and mitigate fraudulent or abusive activities
• Ensure compliance with federal and state healthcare regulations
• Lead design, implementation, and ongoing optimization of pre-payment review process
• Oversee daily volume of claims and monitor program effectiveness through savings, cost avoidance, provider behavior changes, and regulatory compliance metrics
• Utilize claims data analysis, predictive analytics, and fraud detection tools to identify suspicious patterns and activities
• Manage and develop a team of professional certified coders and investigative analysts

Senior Manager – Special Investigations

Business Operations

• Providing operational services, assistance, program implementation, and coordination for one or more day-to-day Medicaid operation functions
• Coordinating recurring state-mandated reports
• Managing regulatory inquiries and operational escalations
• Partnering with stakeholders across Medicaid claims, care coordination, encounters, customer service, and other business areas
• Gathering, validating, and delivering information required by the State of Illinois
• Resolving complex and escalated operational questions
• Working with other areas of the organization on the development, testing, and implementation of program policies, business processes, and system changes

Medicaid Operations Associate – Business Consultant

Customer Support

• Responsible for the day-to-day supervision and management of a remote team of designated inbound and outbound customer service representatives enabling the team to deliver exceptional service.
• Responsible for successful achievement of client service expectations.
• Ensure staff development.

Supervisor, Customer Service

Data Analyst

• Developing and delivering market performance reporting, analytics, and actionable insights
• Collaborating with business leaders to understand reporting and analytical needs
• Translating business requirements into detailed report specifications and meaningful analyses
• Collaborating across cross-functional teams to identify, investigate, and resolve operational issues
• Designing, developing, and maintaining datasets, dashboards, and reports
• Supporting the evaluation of strategic initiatives by analyzing financial, operational, and membership data
• Building strong relationships and ensuring the delivery of high-quality analytical solutions
• Identifying trends, patterns, and key insights within complex datasets

Senior Analytics and Reporting Analyst - Medicare Advantage

Advocate

• Managing and coordinating a high volume of service requests (phone, emails, portal, chat) from employees (and their immediate family) of our clients
• Educating and assisting callers with understanding, navigating through, and obtaining value of their healthcare and wellness benefits
• Providing direction in working through a variety of benefit issues

Benefit Advocate

Medical Reviewer

• Perform accurate and timely medical review of claims suspended for medical necessity
• Initiate and/or respond to correspondence from providers or members concerning medical determinations

Medical Reviewer II

Human Resources

• Provide timely and accurate service to customers (primarily active employees)
• Assist in processing HR documents, i.e. benefit, salary, and status changes
• Provide information on a wide range of human resources programs and services (via phone, chat, AskHR cases)
• Expedite referral of complex issues and sensitive inquiries to the appropriate area for resolution including, but not limited to, benefits, leaves of absence, payroll, HR policy, training, and work-life programs

HR Service Center Rep I

Network Engineer

• Responsible for provider recruitment and contracting of national ancillary providers including large or complex dialysis, laboratory, home infusion, and durable medical equipment providers, for all HCSC plans and lines of business
• Develop proposals and negotiate contracts
• Develop and maintain relationships with providers
• Responsible for education of providers and for ongoing provider service
• Provide subject matter expertise to improve efficiencies and results

Principal Network Management Consultant

Director

• Develop and manage provider contracting and servicing strategies as well as value based care programs for a specific region.
• Accountable for the maintenance, development, negotiation and successful completion of provider network participation contracts. Ensure appropriate coverage of networks for locations.
• Oversee the contracting operations for professional providers and hospitals, for group, government and retail programs.
• Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
• Develop strategies, draft agreements and negotiate contracts for newly recognized categories of providers.
• Oversee the analysis and reporting required to develop payment strategies and take corrective action as needed.
• Accountable for resolution of issues and contractual disputes.
• Ensure staff meets/exceeds goals, objectives and initiatives. Ensure staff is trained, positions are filled, and employees receive communications on changes, etc.
• Accountable for budget, operational reporting and financial reporting.
• Maintain effective communications and provide support to regional counterparts in sales, marketing, and account management.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company related business.
• Maintain effective communication with Vice President, Network Management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

Executive Director, Network Management – Texas Network Contracting

Sales

• Managing a team of sales personnel handling new Supplement Benefit sales through HealthSpring’s National FMO Broker Partners
• Implementing new sales goals on a quarterly basis
• Ensuring the achievement of new sales goals each quarter
• Ensuring positive and productive working relationships with our Topline National FMO Partners, their downline agents and agencies, our Local & Regional sales leaders, as well as various matrix partners across the company

Senior Sales Manager – HealthSpring Supplement Business

Data Scientist

• Own one or more Data Science products that add business value.
• Work closely with customers to understand needs and translate them into data science products.
• Write technical requirements and prioritize product development.
• Coordinate with all interested stakeholders for product success.
• Promote usage and understanding of the product across a broad audience.
• Assist with data science and data engineering tasks as needed.

Senior Data Science Product Manager

Actuary

• Participate in implementation, maintenance, and analysis of actuarial models and systems
• Run and develop complicated models
• Perform detailed analysis of results
• Develop simple written and oral presentations for decision making
• Understand basic business and actuarial concepts