Program Manager Benefit Interpretation Specialist
7 days ago
At Jefferson Health Plans, we are seeking a highly skilled and detail-oriented Program Manager, Benefit Interpretation to join our team. As a key member of our organization, you will be responsible for the direction, coordination, development, evaluation, and compliance of member benefits for all Jefferson Health Plans lines of business.
Key Responsibilities:- Primary subject matter expert in the interpretation of new and existing member benefits for all lines of business
- Collaborate with the compliance team to ensure products are implemented according to existing and new regulations by line of business and industry standards
- Analyze explanation of coverage documents to lead a multi-disciplinary group in determining the best approach for loading benefits offered, including member cost share and out-of-pocket maximums
- Lead the definition of code sets used in benefits configuration and provider reimbursement
- Interpret minimum regulatory requirements for prior authorizations to be used in benefits configuration
- Collect and analyze data to assess and resolve operational obstacles to benefits design optimization
- Serve as JHP's expert on benefit-related legislation
- Maintain documentation necessary for systems analysts to configure benefits
- Develop explanatory information for other departments to better understand benefits configuration across products
- Cultivate collaborative and effective cross-functional relationships with key stakeholders, including sales, marketing, operations, compliance, healthcare management, and finance
- Bachelor's Degree required and 5 years' experience in insurance industry in areas of Benefits Administration, Healthcare Management, or related field. RN and/or certified coder preferred
- Demonstrated experience working with benefit design, preferred Medicare and Medicaid
- Ability to mine data and content, develop presentation, and communicate concepts
- Experience with process improvement concepts and applications
- Excellent communication skills, including the ability to interface with all levels of management
- Detailed-oriented with significant knowledge of healthcare and public policy
- Demonstrated ability to lead and effectively work with multidisciplinary teams
- Strong problem-solving skills
- PC Skills (Word, Excel, PowerPoint)
-
Trade Management Specialist Trainee Program
4 weeks ago
Harrisburg, Pennsylvania, United States Horizon Technologies Full timeHorizon Technologies' Trainee Program for Retail Management SpecialistsWe are a dynamic and innovative company that values teamwork and customer satisfaction. Our stores are the heart of our operations, with a strong presence in the European market. If you have a passion for fashion and a desire to make a difference in people's lives, we want to hear from...
-
Program Specialist 3
4 weeks ago
Harrisburg, Pennsylvania, United States TulaRay Full timeAbout the RoleWe are seeking a highly skilled and experienced Program Specialist 3 to join our team at TulaRay. As a liaison between the Pennsylvania Department of Aging and 52 Area Agencies on Aging, you will play a critical role in ensuring compliance with program standards, policies, and procedures.Key ResponsibilitiesConduct onsite and offsite monitoring...
-
ITSM Program Specialist
3 days ago
Harrisburg, Pennsylvania, United States LingaTech Full timeJob SummaryLingaTech is seeking a highly skilled ITSM Program Specialist to join our team. As a key member of our IT service management team, you will be responsible for providing guidance and input on the prioritization of ITSM initiatives, analyzing and promoting operational efficiencies, and collaborating with cross-functional teams to obtain consensus on...
-
Solid Waste Management Program Supervisor
3 weeks ago
Harrisburg, Pennsylvania, United States Commonwealth of Pennsylvania Full timeJob SummaryWe are seeking a highly skilled and experienced Solid Waste Supervisor to join our team at the Department of Environmental Protection. As a key member of our team, you will be responsible for overseeing the execution of inspection, investigation, and enforcement tasks within the Solid Waste Management Program.Key ResponsibilitiesDirect the daily...
-
SAP HCM Benefits Specialist
3 weeks ago
Harrisburg, Pennsylvania, United States Prequel Solutions Full timeJob Title: SAP HCM Benefits SpecialistPrequel Solutions is seeking a highly skilled SAP HCM Benefits Specialist to join our team. As a key member of our team, you will be responsible for designing, implementing, and maintaining SAP HCM benefits administration solutions.Key Responsibilities:Configure and implement SAP HCM benefits administration modules,...
-
Advanced Illness Management Specialist
2 weeks ago
Harrisburg, Pennsylvania, United States Illumia Full timeAbout IllumiaIllumia Health is a fast-growing part of Gentiva, an industry leader in hospice and palliative care. Our clinical teams serve as an extension of physicians' care, partnering with them and other specialists to offer advanced illness management, a specialized form of high-touch palliative care designed to provide relief from the symptoms and...
-
Technical Sales Training Program Specialist
1 month ago
Harrisburg, Pennsylvania, United States Trane Technologies Full timeAbout the RoleWe are seeking a highly motivated and detail-oriented individual to join our Commercial HVAC Sales team as a Technical Sales Training Program Specialist. As a key member of our team, you will be responsible for developing and implementing sales strategies to drive business growth and customer satisfaction.Key ResponsibilitiesSell the world's...
-
Trade Management Specialist Trainee
3 weeks ago
Harrisburg, Pennsylvania, United States Horizon Technologies Full timeUnlock Your Potential as a Retail Management SpecialistAt Horizon Technologies, we're passionate about fashion and committed to making families happy through excellent advice and the right offer. As a retail management specialist, you'll play a vital role in shaping our company's success.Our Trainee ProgramOur trainee program for retail management...
-
Technical Sales Training Program Specialist
1 month ago
Harrisburg, Pennsylvania, United States Trane Technologies Full timeAbout Trane TechnologiesWe are a leading provider of innovative climate solutions for buildings, homes, and transportation. Our mission is to create a sustainable world by developing and delivering cutting-edge products and services that challenge what's possible.Job SummaryWe are seeking a highly motivated and talented individual to join our team as a...
-
Technical Sales Training Program Specialist
4 weeks ago
Harrisburg, Pennsylvania, United States Trane Technologies Full timeAbout Trane TechnologiesWe are a leading provider of innovative climate solutions for buildings, homes, and transportation. Our mission is to create a sustainable world by developing and delivering cutting-edge products and services that challenge what's possible.Job SummaryWe are seeking a highly motivated and talented individual to join our team as a...
-
Technical Sales Training Program Specialist
1 month ago
Harrisburg, Pennsylvania, United States Trane Technologies Full timeAbout the RoleWe are seeking a highly motivated and detail-oriented individual to join our team as a Technical Sales Training Program Specialist. As a key member of our Commercial HVAC sales team, you will be responsible for selling the world's most complete line of efficient heating, ventilating, and air conditioning (HVAC) equipment and building management...
-
Travel Nurse RN Long Term Acute Care Specialist
3 weeks ago
Harrisburg, Pennsylvania, United States MedPro Healthcare Staffing Full timeJob Title: Travel Nurse RN Long Term Acute Care SpecialistWe are seeking a skilled Travel Nurse RN Long Term Acute Care Specialist to join our team at MedPro Healthcare Staffing. As a Long Term Acute Care Nurse, you will be responsible for providing high-quality patient care in a fast-paced environment.Job Summary:As a Travel Nurse RN Long Term Acute Care...
-
Harrisburg, Pennsylvania, United States UPMC Full timeJob SummaryUPMC is seeking a highly skilled Pharmacist to join our team as a Hospital/Inpatient Medication Management Specialist. As a key member of our pharmacy team, you will be responsible for providing safe, effective, and cost-effective pharmacotherapy to our patients.Key ResponsibilitiesMedication Therapy Management: Interpret and evaluate physician...
-
DDC/BAS Controls Specialist
4 weeks ago
Harrisburg, Pennsylvania, United States Jobot Full timeJob Title: DDC/BAS Controls Specialist Job Summary: Jobot is seeking a highly skilled DDC/BAS Controls Specialist to join our team in South Central California. As a key member of our team, you will be responsible for designing, starting up, commissioning, and servicing HVAC Direct Digital Controls projects. Responsibilities: * Design and develop building...
-
Fiscal Management Specialist
2 weeks ago
Harrisburg, Pennsylvania, United States Commonwealth of Pennsylvania Full timeAbout the RoleWe are seeking a highly skilled Fiscal Management Specialist to join our team at the Commonwealth of Pennsylvania. As a key member of our department, you will play a critical role in ensuring the effective management of fiscal resources and grants.Key ResponsibilitiesOversee all grants and provide monthly status reports to the Division...
-
Fiscal Management Specialist
1 week ago
Harrisburg, Pennsylvania, United States Commonwealth of Pennsylvania Full timeAbout the RoleWe are seeking a highly skilled Fiscal Management Specialist to join our team at the Commonwealth of Pennsylvania. As a key member of our team, you will play a critical role in ensuring the financial integrity of our programs and services.Key ResponsibilitiesOversee the fiscal components of Federal Funded Programs, including budgetary...
-
Account Manager
1 month ago
Harrisburg, Pennsylvania, United States Sedgwick Full timeAbout the RoleSedgwick is seeking a highly skilled and experienced Account Consultant to join our team. As an Account Consultant, you will play a critical role in managing claim caseloads, mentoring team members, and ensuring compliance with jurisdictional requirements.Key ResponsibilitiesClaim Management: Utilize special account instructions to obtain...
-
Client Support Specialist
2 weeks ago
Harrisburg, Pennsylvania, United States cyberThink Full timeJob Title: Client Support SpecialistAt cyberThink, we are seeking a highly skilled Client Support Specialist to join our team. This role will play a critical part in the management and coordination of current and new business development, pension plan contract management, client satisfaction, and dispute resolution.Key Responsibilities:Communication and...
-
Senior Coding Specialist
3 days ago
Harrisburg, Pennsylvania, United States Highmark Health Full timeJob SummaryWe are seeking a highly skilled Senior Coding Specialist to join our team at Highmark Health. As a key member of our coding team, you will be responsible for reviewing and interpreting medical records to abstract accurate and relevant data.Key ResponsibilitiesReview and interpret medical records to determine appropriate ICD codes for diagnoses and...
-
Product Attorney
4 weeks ago
Harrisburg, Pennsylvania, United States Eaton Corporation Full timeProduct Attorney - Cybersecurity SpecialistEaton Corporation is seeking a highly skilled and motivated Product Attorney specializing in Cybersecurity to join our team. This role is a hybrid work model and is based in Cleveland, OH or Pittsburgh, PA.Position OverviewThe successful candidate will collaborate closely with cross-functional teams across the globe...