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Displaying results 1 - 15 of 100

Provider Data Management Specialist I

Celtic Insurance Company - Bedford, NH

Position Purpose: Maintain accurate databases and reports to monitor network compliance with State requirements Create and maintain multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections Oversee the provider termination process including adding and changing new or existing provid...

Application Deadline: None

Manager, Government Affairs

Celtic Insurance Company - Waltham, MA

Position Purpose: Establish and implement government relations goals and objectives and other cross functional responsibilities. Represent the Health Plan as one of the primary points of contact with State elected officials and government agencies. Oversee all departmental collateral materials including position papers and issue presentations including researching, reporting, and...

Application Deadline: None

Vice President, Operations

Celtic Insurance Company - Bedford, NH

Position Purpose: Oversee all health plan operations, procurement opportunities, new product implementations and complex initiatives for business development utilizing cross-functional business units and corporate teams to meet business unit and corporate strategic objectives Partner with multiple stakeholders and business unit leadership to establish strategic visions, operation...

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

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

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

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

Manager, Customer Service

Celtic Insurance Company - Waltham, MA

Position Purpose: Plan and manage assigned customer service function at the health plan to meet overall business goals and objectives. Manage the workflow of the customer service function and communicate standards Analyze department performance; develop, implement and maintain production/performance standards in line with Company goals and objectives E...

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

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 productio...

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

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 Cond...

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

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