Jobs: emblemhealth

**Come Join Us On-site Interviews for Marketplace Sales** **Wednesday, May 1, 2024** **55 Water Street, New York, NY 10041** **8:00am to 12:00pm & 2:00pm to 6:00pm** Our on-site interviews include a presentation from the business on the role, meet with one of our sales leaders, and if selected you will be asked to present a “mock sales pitch.” We...

Summary of Job Partner with Pharmacy and Pharmacy delegates (and others as assigned) to ensure they are in full compliance with all actionable and informational regulatory notices. Identify new and revised regulatory guidance; create paths of communication to business units. Ensure that Pharmacy (and other business areas as assigned) has implemented...

**Come Join Us On-site Interviews for Marketplace Sales** **Wednesday, May 1, 2024** **55 Water Street, New York, NY 10041** **8:00am to 12:00pm & 2:00pm to 6:00pm** Our on-site interviews include a presentation from the business on the role, meet with one of our sales leaders, and if selected you will be asked to present a “mock sales pitch.” We...

Summary:Provide the analytical resources necessary for the development of overall pricing and reserve setting strategies.Lead projects to analyze current rate structures and develop improvements and alternatives.Coordinate the actuarial staff as needed to support the activities of the affiliates.Lead actuarial staff as needed to support the activities of the...

Summary of Job Ensure prompt, efficient, accurate and timely claims adjudication of high dollar claims in accordance with the current policy benefits, limitations or exclusions. Provide resolution of provider inquiries and collaborate with internal departments. Provide feedback or suggestions to enhance current processes and/or systems. Responsibilities:...

Summary:Lead a team to create and implement sophisticated analytics and provide support for strategic and business decision-making.Identify and address expected and unforeseen data complexities to mitigate their impact on the analytic outcome and associated business decisions.Responsible for the development of predictive analytics modeling to assist the...

Summary:Lead a team to create and implement sophisticated analytics and provide support for strategic and business decision-making.Identify and address expected and unforeseen data complexities to mitigate their impact on the analytic outcome and associated business decisions.Responsible for the development of predictive analytics modeling to assist the...

Summary:* Work with other team leaders to improve operational efficiencies and resource allocations for improved performance of the EmblemHealth plans.* Responsible for running queries and providing required analysis to understand related drivers (such as medical cost and utilization), and to provide insightful commentary and sensitivity modeling analysis.*...

Summary of Job:Assess eligibility of members in need of community based long term support services (CBLTSS). Conduct UAS assessment in the members home or by telehealth (under NY State's regulations), and at skilled nursing facilities. Consult with health care providers to support assessment outcomes. Conduct needs assessment utilizing the UAS-NY/DOH tool to...

Job Title: Director of Actuarial ServicesLocation: New York, NY (Remote)About Us: A leading health insurance and wellness company committed to improving the health and well-being of individuals, families, and communities in New York. We are dedicated to providing high-quality, affordable healthcare solutions that meet the diverse needs of our members.Role...

Northeast Employed Pediatrics$250K+ First Year PotentialBusy from day 1 - Acquire existing patient base, little to no competition in surrounding area.Practice located in a new, beautiful building with state of the art equipment and functional layout.Tenured support staff – 3 Nurse Practitioners, 1 LPN, 1 Medical Assistant & 2 administrative...

Northeast Employed Pediatrics$250K+ First Year PotentialBusy from day 1 - Acquire existing patient base, little to no competition in surrounding area.Practice located in a new, beautiful building with state of the art equipment and functional layout.Tenured support staff â 3 Nurse Practitioners, 1 LPN, 1 Medical Assistant & 2 administrative...