• Provide day-to-day support for Macmillan’s distribution team • Partner closely with Sales, Operations, and Clients to ensure accurate materials and smooth execution across publishing cycles • Prepare materials for launch meetings • Support Sales Conference readiness by ensuring titles are updated • Conduct seasonal audits to confirm metadata is complete and accurate • Assist with weekly reporting by pulling P&B (print and bind) and reprint detail sheets • Act as a point of contact for sales materials requests • Run and distribute weekly sales and inventory reports • Provide administrative and project support to the Client Services teams

Role Description This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound calls, creating authorizations via phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment. Essential Accountabilities: - Facilitates inbound and outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center environment. - Responds to customers in a professional, efficient manner to encourage public acceptance of products, services, and policies. - Perform triage for UM Services. - Serves as the primary contact for providers regarding authorization requests. - Contacts members and providers concerning regulatory requirements relating to Department of Health (DOH) notifications and other regulatory requirements such as the National Committee for Quality Assurance (NCQA) guidelines. - Provides timely response to all research inquiries from other departments and assures the response is thorough, accurate, and within regulatory timeframes. - Processes fax requests from the designated fax and system queues. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. - Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. - Regular and reliable attendance is expected and required. - Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) - Assists and performs tasks associated with project and departmental management. - Backup Team Leads by assisting with questions when needed. - Work on assigned offline projects. - Provides, prepares, and assists with preliminary support to multiple levels of providers and or members (as well as others as needed), including but not limited to physicians, skilled nursing facilities, mid-level providers, members, pharmacies, pharmacists, and support staff. - Provide one-on-one support, coaching, and training to UM Services Reps. - Collaborates with other key departments (Claims, Customer Service, related care management units) to ensure end-to-end process for authorizations, telephonic notifications, and/or care management referrals is accurate and complete. Level III (in addition to Level II Accountabilities) - Assists Team Leads with assigned tasks when necessary (including but not limited to authorizations, claims, care management referrals, monitoring and controlling inventory levels/call queues, timeliness, reporting). - Meet departmental requirements for Facets UM Services workflows and PEGA. - Resolves escalated customer questions and complex concerns. - Assists Medical Directors with scheduling Fair Hearings. - Assists with coordinating Grievance and Appeals requests. - Assist with all Blue Card Claims escalations. - Assist management with the review and creation of desk level procedures, acting as a subject matter expert for UM Services. Qualifications - High School Diploma or GED. - Experience with using a desktop computer in a professional environment, preferably with Microsoft Office Products. - Call center experience preferred, not required. - Strong analytical and problem-solving skills. - Strong written and verbal communication skills and ability to work within a team. - Demonstrated organizational skills to manage multiple projects and priorities. - Self-motivated and able to work independently, as well as on intra- and inter-departmental teams where needed. Level II (in addition to Level I Qualifications) - 2 years’ experience working with managed care or healthcare industry. - Ability to apply in-depth knowledge of complex rules, such as those of the authorization process, regulatory processes/time frames, care management systems and processes, departmental policies and procedures, product lines, and contract benefits. - Advanced skills working between multiple programs and applications simultaneously. - Demonstrates willingness to develop collaborative solutions to achieve a better end-to-end process. - Demonstrates proficiency in basic navigation and utilization of department specific applications. - Demonstrates role-specific competencies as it pertains to their work unit on a consistent basis. - Active demonstration of broad knowledge base and positive work habits as evidenced by ability to train new staff, take on new challenges, flexibility in work assignments, and participation in meetings and projects as assigned. Level III (in addition to Level II Qualifications) - 4 years’ experience working with managed care or healthcare industry. - Demonstrates a thorough knowledge and understanding of sources of information about health plan contracts, riders, policy statements, and procedures to identify eligibility and coverage and assisting other staff and other areas within the company with related inquiries. - Demonstrates operational knowledge of FACETS application and workflow processes. - Ability to resolve/respond to customer inquiries across multiple plans with limited assistance. - Ability to collaborate within the organization when issues arise with limited assistance. - Ability to identify potential systemic issues and report as necessary without supervisor assistance. Physical Requirements - Ability to work prolonged periods sitting at a workstation and working on a computer. - Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. - Ability to work in a home office for continuous periods of time for business continuity. - Ability to travel across the Health Plan service region for meetings and/or trainings as needed. - Manual dexterity including fine finger motion required. - Repetitive motion required. - The ability to hear, understand and speak clearly while using a phone, with or without a headset. Compensation Range(s) N3 - Min $20.00 Max $26.90 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Role Description As a Representative, you will support and service 457 Retirement accounts, assisting with inquiries, rollovers, distributions, loan processing, and educating participants on products, services, and online tools. - Receives and responds to incoming calls from investment professionals, plan sponsors, and members on a variety of topics. - Understands the different product suites, including current line-up and products no longer sold that still require servicing. - Responsible for interpreting and applying all changes and enhancements to new and old products, based on daily change communications. - Identifies the question(s) behind the question to proactively offer consultative expertise and uncover the unstated need. - Maintains a record of conversations and follows a process of documentation to support our strategy of knowing our member better than anyone. - Follows all rules and regulations to ensure compliance with FINRA or other professional licensure requirements, Nationwide policies, firms, plan documents, and state and local laws. - Educates customers to ensure understanding of tax implications, penalties/surrender charges, death benefit protection, lifetime income, capital preservation, and/or benefits pertaining to the plan/contract. - Analyzes problems to determine proper course of action, striving for first-time final resolution. - Works with internal partners to resolve escalated issues when necessary. - Integrates lean methodology into daily interactions through problem-solving meetings and team huddles. - Develops and grows through monthly individual meetings with leadership to set in place a career path strategy. - May perform other responsibilities as assigned. Qualifications - High school diploma or equivalent required. - Undergraduate degree in finance, business administration, insurance, economics, communications preferred. - One year of experience in customer service, sales-related occupations. - Knowledge of various insurance products and the sales process. - Excellent verbal and written communication skills. - Proficiency with computers and common office software. Requirements - This position requires the SIE, Series 6, and Series 63 licenses. - SIE must be completed within 120 days of employment. - Series 6 & 63 must be completed within 180 days. Benefits - Minimum salary: $47,151 ($23.40/hr). - PTO, 401(k) with match, pension plan. - Medical, dental, vision (day one). - Hybrid/remote opportunities. - Educational assistance. - Exclusive insurance discounts.

Role Description At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. The Strategic Services Associate supports the management team and acts as a liaison to stakeholders (service lines, clinic leadership, providers, revenue managers, revenue cycle operational teams, etc.) to support eligibility, prior authorization, and medical necessity standardized processes. This position evaluates and implements sustainable system workflows that improve operational performance and clear lines of responsibility between clinical, clinic, and pre-service verification teams. The Strategic Services Associate contributes to the achievement of department goals through the development and leadership of performance improvement activities. Duties and Responsibilities of this Level: - Performance Improvement (60%) - Design and implement strategies for enhancing performance, reducing denials, and write-offs through utilization of performance improvement techniques and methodologies. - Evaluate operational workflows and identify components that will improve operational efficiency by leveraging technology/bot/automation. - Implement and maintain technology solutions for the department. - Recommend policy/procedure and training documentation related to initiatives and projects. - Establish department performance targets. - Maintain full knowledge of departmental operations and act as a subject matter expert for eligibility, authorization, and medical necessity. - Develop, maintain, and enhance knowledge of Electronic Health Record system and third-party vendor functionality to support recommendations on optimal workflows. - Serve as an expert resource on performance improvement methodologies. - Collaboration (30%) - Maintain liaison with service line and other revenue cycle departments as it relates to pre-service verification operations. - Partner with supporting clinics to educate on pre-service verification processes and resolve system related workflows impacting operations. - Communicate overall strategy for departmental improvement and develop strategies to meet performance metrics. - Serve as a project manager for interdisciplinary teams. - Ensure adequate training and documentation is provided on new and changing processes. - Other Duties (10%) - Promote PRMO strategic vision, mission, and purpose while emphasizing teamwork and results. - Support organizational diversity and equal treatment for all employees. - Create and foster a department culture that provides a satisfying and enriching environment in which staff can be developed and retained. - Interact with and provide timely verbal/written responses to all stakeholders (patients, providers, payors, and departmental personnel). - Acknowledge management requests and emails in a professional, timely manner. - Attend meetings and participate in Work Culture initiatives, committees or workgroups, as assigned. - Accomplish all tasks as assigned. - Perform other related duties incidental to work described herein. Qualifications - A bachelor’s degree in a business or health-related field is required. Requirements - Minimum of 5 years work experience, including 3 years of experience with significant responsibility for performance/process improvement. - Experience leading work teams required. - Effective written and verbal communication skills. - Ability to communicate with customers/staff with diverse educational backgrounds. - Analysis of data and processes for opportunities for improvement. - Ability to manage numerous diverse projects simultaneously through effective priority setting, efficient use of time, organization. - Knowledge of revenue cycle operations. - Attention to detail and accuracy. - Computer literacy. Benefits - Relocation Assistance (based on eligibility). - REMOTE POSITION: Monday - Friday (First Shift).