EmblemHealth
  • New York, NY, USA
May 24, 2022  
Summary of Position We seek a dynamic Healthcare Recruiter to partner with the Lead Recruiter and Director of Talent Acquisition to develop and implement talent acquisition sourcing plans to support various business functions and levels within the company. The recruiter will handle all facets of the recruiting process, including interviewing, skill assessment, candidate evaluation, applicant tracking and referrals, on-boarding, posting job ads on the company's website, social media channels, and relevant, diverse job boards to drive DEI strategy, engagement, employer branding, and culture consistent with company mission, vision, and values. Principal Accountabilities •   Work with the Lead Recruiter and Director of Talent Acquisition to develop staffing models that maximize utilization and profitability while maintaining employee morale and commitment. •   Interview and assess candidates' qualifications using behavioral/competency-based assessment tools; present...
EmblemHealth New York, NY, United States
May 18, 2022  
Disrupt the traditional wellness point-solutions model by fueling the prospect pipeline for WSH’s products and services. Increase market awareness of WSH capabilities; locate, research, source and qualify prospects across multiple sales channels. Develop and cultivate relationships to increase WSH awareness and market penetration. Responsibilities: Generate new leads; find new potential sales outlets; build and enhance relationships to nurture prospects. Perform outbound calls daily to identify prospective new clients; conduct cold calling and follow up emails to contact and qualify new sales opportunities.  Collaborate with members of the sales team to discuss sales strategy, tactics, deliverables, etc. Cultivate, manage and maintain a pipeline of interested prospects and engage sales executives. Identify and research prospects to establish business relationships. Develop relationships with prospects over the phone and off the back of marketing campaigns....
EmblemHealth Farmington, CT, United States
May 18, 2022  
Summary of Position •   Analyze and report on operational metrics based on key performance indicators and benchmarked industry standards and targets to support the organization.  •   Propose and advocate for methodologies throughout HR; collaborate with subject matter experts (e.g., EPMO) and business partners to create and deploy tools and best analytic practices.   •   Implement and deliver meaningful metrics and dashboards to HR leaders, business partners and senior management. •   Provide subject matter expertise for maintaining an HR data warehouse and implementing enhancements. Principal Accountabilities •   Analyze data to identify trends on specific HR/Business metrics, including key performance indicators related to workforce data.  Identify, analyze and report on key data, information and trends, applying a metrics and benchmarking philosophy to HR service delivery.  •   Maintain HR’s metrics/dashboard methodologies and advocate proactive and strategic...
EmblemHealth New York, NY, United States
May 18, 2022  
Summary of Job: Serve as pharmacy systems coding subject matter expert with a focus on medical drug claim processing, review of utilization management, PA processing, and appeals. Support and sponsor pharmacy system projects/implementation for medical drug claims and medical PA. Provide technical and SME support for projects. Liaison between IT and any key stakeholders/vendors/pharmacy systems or systems owners. Responsibilities: Collaborate in defining, gathering, reviewing, and editing business requirements for system updates, enhancements and migrations for claims projects. Manage all project documentation for presentation and reporting; ex. business requirements, test packet, status and prioritization for a variety of audiences including Senior Management, Care Management, Pharmacy Services and CM Data Systems customers. Perform solution analysis review and provide concise direction to ensure that the proposed system solution meets established business...
EmblemHealth New York, NY, United States
May 18, 2022  
Summary of Position •   Accountable for development and maintenance activities for formularies on the following lines of business: Medicare Part D, Medicaid, Commercial, Healthcare Exchange ensuring compliance with state and federal requirements.   •   Responsible to conduct competitive analysis of our formularies against our competitors and recommend formulary changes to support business development efforts.   •   Direct the strategy for medical drug rebates including working with our consultant, Burchfield/AON, to complete a market RFP to optimize rebates.   Collaborate with Pharmacy Analytics in reporting rebate income.  Ensure medical policy appropriateness to further enhance rebate opportunities.  •   Define medical drug policies for all lines of business, ensure accurate set up in FACETs through collaboration with the RPC team.  Work with compliance and legal to ensure compliance with state and federal regulations.  •   Accountable e for the development and...
EmblemHealth New York, NY, United States
May 18, 2022  
Continuously and proactively assess and monitor vendor operations performance to achieve contractual targets daily. Frequently interface with Vendor Operations Tower Leaders to continuously identify and communicate opportunities for improvement with enrollment/ billing/collection processes. Identify areas of improvements in operational areas, provide appropriate action plans, develop and implement Vendor Operations performance analysis programs and metrics to improve operational efficiency. Personally, own the EmblemHealth and CCI brand and customer experience by directing day-to-day vendor operations and establishing seamless cadence with line management counterparts at each vendor.   Responsibilities: Assess and monitor performance of vendors for each core process to meet contractual requirements and align with the enterprise customer experience objectives. Conduct reviews, transactional audits, and compliance and operational procedure reviews. Work with various...
EmblemHealth New York, NY, United States
May 18, 2022  
Summary of Job: Responsible for the data and reporting necessary to support EmblemHealth’s Sales Operations team to meet sales and business objectives for EmblemHealth.  Leverage practical process, data, and technology solutions to deliver timely sales reporting.   Collaborate with internal stakeholders to enhance sales reporting and operation processes that balances both the needs of the company and sales efficiency. Deliver critical reporting and data analysis in support of client growth and retention. Work collaboratively with others across Data, Sales, Product, Medical Economics, Account Management and Finance to deliver on Sales operations activities.  Serve as a key operational partner to our client-facing and revenue producing teams. Requirements: Provide network sales support: repricing and analysis of claim discount information.  Serve as point person with Cognizant for producing reports and requirements. Participate in external/internal conference calls....
EmblemHealth New York, NY, United States
May 18, 2022  
Summary of Job: Manage vendor payments and reconciliation functions to ensure the timeliness and accuracy of capitation payments to the company’s medical groups, delegated entities (“IPA’s”) and certain ancillary providers. Prepare monthly vendor financial statements and other financial analyses for both internal and external distribution to ensure payments are in accordance with contracts/agreements. Responsibilities: Prepare monthly capitation workbooks in accordance with medical group, IPA and certain ancillary provider contracts for both internal and external distribution and analysis. Ensure that capitation payments are accurately calculated and promptly disbursed. Work with the Provider Relations and Group Practice departments on vendor payment questions as they arise pertaining to delegated entities’ delivery systems. Ensure the accuracy and timeliness of other payments, such as quality and operational incentives, professional pools, etc. Provide supporting...
EmblemHealth Farmington, CT, United States
May 18, 2022  
Summary Oversee accounting and analysis functions for medical expense. Ensure that the monthly close for EmblemHealth is performed timely, accurately and in accordance with generally accepted accounting principles (GAAP). Review and prepare journal entries, account reconciliations and other analyses.   Participate in the development and enhancement of internal controls over financial reporting and process improvements to streamline the monthly close process. Responsibilities Assist in managing the monthly medical expense accounting close processes.  Ensure that journal entries, account reconciliations and other analyses are prepared in a complete, accurate and timely manner and that financial information is recorded in accordance with GAAP.  Identify and implement process improvements to achieve a 10-business day close and to ensure compliance with corporate policy and MAR controls.  Streamline the close process through automation to eliminate manual processes and...
EmblemHealth New York, NY, United States
May 16, 2022  
Summary Perform activities related to Corporate Insurance Risk Management policy renewals (Directors and Officers Liability, Employment Practices Liability, Managed Care Professional Liability, Property and Casualty, Cyber Risk, Workers’ Compensation, etc.) to secure commercial insurance coverages.  Manage requests for certificates / identification cards; assist Risk Management Specialist as needed to track / monitor / execute on vendor contract analysis partnering with Legal and Procurement; and manage / coordinate / process to track Corporate Commercial claim / litigation filings, notices, documents, requests and correspondence.   Responsibilties Prepare/provide support for: submissions; disclosures for insurance policy renewals; obtaining new insurance coverage; tracking and managing certificate issuance; contract review; and new risk assessment tracking.  Provide support as needed in Contracts / RFPs, partnering with Legal and Procurement to provide Risk...
EmblemHealth New York, NY, United States
May 16, 2022  
Summary of Job: Serve as pharmacy systems coding subject matter expert with a focus on medical drug claim processing, review of utilization management, PA processing, and appeals. Support and sponsor pharmacy system projects/implementation for medical drug claims and medical PA. Provide technical and SME support for projects. Liaison between IT and any key stakeholders/vendors/pharmacy systems or systems owners. Responsibilities: Collaborate in defining, gathering, reviewing, and editing business requirements for system updates, enhancements and migrations for claims projects. Manage all project documentation for presentation and reporting; ex. business requirements, test packet, status and prioritization for a variety of audiences including Senior Management, Care Management, Pharmacy Services and CM Data Systems customers. Perform solution analysis review and provide concise direction to ensure that the proposed system solution meets established business...
EmblemHealth Remote * (New York, NY, USA)
May 16, 2022  
Summary of Job: Responsible for the data and reporting necessary to support EmblemHealth's Sales Operations team to meet sales and business objectives for EmblemHealth. Leverage practical process, data, and technology solutions to deliver timely sales reporting. Collaborate with internal stakeholders to enhance sales reporting and operation processes that balances both the needs of the company and sales efficiency. Deliver critical reporting and data analysis in support of client growth and retention. Work collaboratively with others across Data, Sales, Product, Medical Economics, Account Management and Finance to deliver on Sales operations activities. Serve as a key operational partner to our client-facing and revenue producing teams. Requirements: Provide network sales support: repricing and analysis of claim discount information. Serve as point person with Cognizant for producing reports and requirements. Participate in external/internal conference calls....
EmblemHealth Remote * (New York, NY, USA)