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Displaying results 1 - 15 of 100

GIS Technician - Atlanta, GA (Downtown)

Southern Company - Atlanta, GA

Do you have an associates or bachelor's degree in GIS or Geography, certification in GIS or related work experience in this field?  If so, Georgia Power has an opportunity in Atlanta for you!   GIS Technician - Downtown Atlanta - Geographic Solutions and Services (GSS) at Georgia Power (Subsidiary of Southern Company)   Location: 755 J...

Application Deadline: None

Transmission Planning Engineer

Southern Company - Birmingham, AL

This position performs dynamic simulations for transmission planning studies on the Southern Company bulk power system.  These studies involve voltage stability, transient stability, underfrequency and undervoltage load shedding, FIDVR, out-of-step protection, generation interconnections (GIs), transmission service requests (TSRs), regional planning with neighboring transmission systems, and ge...

Application Deadline: None

Senior Concurrent Review Nurse

Celtic Insurance Company - Waltham, MA

Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward r...

Application Deadline: None

Manager, Clinical Pharmacy Services

Celtic Insurance Company - Bedford, NH

Position Purpose: Oversee the clinical pharmacy services function and develop new quality improvement and revenue enhancement activities Ensure all prior authorization requests are reviewed and completed accurately and timely Assist with prior authorizations and determinations for appropriate drug products for complex or escalated requests Research and...

Application Deadline: None

Customer Service Representative I (Member)

Celtic Insurance Company - Waltham, MA

Position Purpose: Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner. Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources Provide assistance to members and/or providers regarding website...

Application Deadline: None

Network Claims Liaison II

Celtic Insurance Company - Bedford, NH

Position Purpose: Serve as the claims payment expert for the Plan and as a liaison between the plan, claims, and various departments to effectively identify and resolve claims issues. Act as the subject matter expert for other Claims Liaisons. Analyze trends in claims processing issues and identify work process solutions Lead meetings with various departments to ass...

Application Deadline: None

Care Manager II (RN)

Celtic Insurance Company - Waltham, MA

Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and pro...

Application Deadline: None

Manager, Provider Network Performance

Celtic Insurance Company - Waltham, MA

Position Purpose: Manage and support the development of network performance analytics. Design and build solutions that create, maintain, interface, or transform data in order to support a complete business need around contracting analytics and modeling applications. Oversee the development of project applications and determine the financial impact of contract negotiations and sta...

Application Deadline: None

Customer Service Representative I (Provider)

Celtic Insurance Company - Waltham, MA

Position Purpose: Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner. Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources Provide assistance to members and/or providers regarding website...

Application Deadline: None

Referral Specialist I

Celtic Insurance Company - Waltham, MA

Position Purpose: Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits A...

Application Deadline: None

Customer Service Representative I

Celtic Insurance Company - Waltham, MA

Position Purpose: Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner. Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources Provide assistance to members and/or providers regarding website...

Application Deadline: None

Provider Relations Specialist I (Western, MA)

Celtic Insurance Company - Waltham, MA

Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices. Serve as primary contact for providers serving as a liaison between the provider and the health plan Co...

Application Deadline: None

Manager, Provider Network Performance

Celtic Insurance Company - Bedford, NH

Position Purpose: Manage and support the development of network performance analytics. Design and build solutions that create, maintain, interface, or transform data in order to support a complete business need around contracting analytics and modeling applications. Oversee the development of project applications and determine the financial impact of contract negotiations and sta...

Application Deadline: None

Manager, Provider Relations

Celtic Insurance Company - Waltham, MA

Position Purpose: Responsible for maintaining existing and developing new provider relations, and assisting with contracting activities Manage the staff in contracting area including work flow, training and communication standards Manage day-to-day provider relations activities and provider relations department Develop, implement and maintain produc...

Application Deadline: None

Lead Customer Service Representative

Celtic Insurance Company - Bedford, NH

Position Purpose: Serve as a liaison between Customer Service Representatives CSRs), management and other various departments. Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner. Qualifications Education/Experience: High school diploma or equivalent. Associate's degree and claims processing, billing and/or coding ...

Application Deadline: None
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