Market Liaison Resolution Specialist

GeneralGeneralFull TimeRemoteMid LevelTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany SiteLinkedIn

Location

United States

Posted

1 day ago

Salary

$54.5K - $87.3K / year

Seniority

Mid Level

Bachelor Degree2 yrs expExperience acceptedEnglish

Job Description

Market Liaison Resolution Specialist

CareSource

• Achieving resolution of Operational Intakes by the Market Liaison Support Services Research Team • Conduct detailed reviews and document findings • Collaborate with various departments including contracting, credentialing, claims, and IT • Investigate Market State Complaint tasks • Meet Service Level Agreements (SLA) • Generate reports to determine claim impact • Adjust impacted claims and assist in adjudication • Identify opportunities for process improvements • Participate in User Acceptance Training of system issues • Communicate effectively with internal departments • Assist the market proactively by evaluating risks

Job Requirements

  • Bachelor's degree required
  • Two (2) years of experience in managed care operations required
  • Knowledge of Medicaid/Medicare
  • Familiarity with healthcare industry
  • Understanding of Provider Contracting applications
  • Advanced troubleshooting and problem-solving capabilities
  • Overall knowledge of Managed Care Operations-related systems, medical coding, technical specifications, and processes
  • Solid understanding of claims processing
  • Proficient in Microsoft Office Suite
  • Effective organization, time management, and prioritization skills

Benefits

  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development opportunities
  • Bonuses

Related Categories

Related Job Pages

More General Jobs

Urrly logo

Travel Medical Assistant

Urrly

Empowering People and Property Management companies with future proof staffing solutions.

General1 day ago
Full TimeRemoteTeam 1-10H1B No Sponsor

• Visit patients in their homes, not exam rooms • Complete Annual Wellness Visits (Medicare) and Well-Child Visits • Focus on prevention, not urgent care • Build patient relationships, no rushed visits • Support seniors and families at home • Document visits in modern EMR tools

Pennsylvania
$31 / hour
Palomar logo

Senior Underwriter

Palomar

Reimagining specialty property and casualty insurance with creative solutions that provide better protection.

General1 day ago
Full TimeRemoteTeam 201-500Since 2014H1B No Sponsor

Role Description We are looking for an experienced Senior Underwriter for our primary casualty lines. Successful candidates must be able to produce and manage a profitable book of business through the development of relationships with brokers and customers. You will use our proprietary software to help you achieve results and share your industry expertise with other underwriters on your team. - Select, price, quote and review new & renewal business in accordance with company underwriting guidelines and experienced underwriting judgment. - Independently work with assigned distribution channel to appropriately select risks, evaluate and recommend program structure, services and pricing to achieve a balanced portfolio and long-term profitability. - Establish and maintain strong business relationships to develop new opportunities as well as visit brokers/producers to retain existing accounts in support of the producer and territory management plan. - Be well versed in underwriting General Liability, Business Auto and Excess Liability for contractors and real estate risks. - Independently review underwriting information to assess risk quality and compliance within company guidelines. - Evaluate reinsurance requirements and implement appropriate action. - Lead the development and coaching of the underwriting team, sharing knowledge of industry-specific specialty with underwriters of all levels and being seen as a technical underwriting resource. - Communicate and collaborate across disciplines to establish and maintain relationships to achieve organizational and policyholder success. - Actively continue to improve personal knowledge and practices of the insurance industry through work experience, in-house instruction, insurance-specific designations (e.g. CPCU), industry courses, home office seminars and workshops, etc. Qualifications - Minimum 5 years of current underwriting insurance experience - Bachelor’s degree highly preferred - Excellent communication skills, both verbal and written - Ability to apply underwriting/appetite, tools, systems, and resources to achieve goals, solve complex problems - Able to quickly establish and build healthy working relationships, excels in mentoring relationships - Drives for results and takes initiative to help support the team - Ability to quickly learn and work in various technical platforms - CPCU or professional insurance designation strongly preferred - Professional, analytical, and adaptable attitude - Ability to organize, self-prioritize, and be a self-starter in a fast-paced environment with demanding internal and external deadlines Benefits - Full Suite of Medical Benefits - Long Term Financial Incentives – STOCK! - 401k with 3.5% Automatic Fully Vested Employer Contributions - Competitive PTO + Holiday Program - Lifestyle Spending Allowance - Professional Development Assistance - Career Exploration Opportunities - Regular company-wide social events (even virtually!) Company Description At Palomar, we are committed to diversity, equality and inclusion in all facets of the organization. We have built an open culture that celebrates the diversity of our workforce, while actively championing equality and inclusion practices that make us a company people want to work with and work for. We believe that diversity, equality and inclusion yields greater organizational creativity and productivity, which helps us serve our customers and partners more effectively.

United States
$97.5K - $135K / year
Mercury Insurance logo

Appraisal Specialist

Mercury Insurance

Trusted by customers. Loved by team members. The smarter way to career.

General1 day ago
Full TimeRemoteTeam 5,001-10,000Since 1962H1B Sponsor

• Research actual cash value of vehicles by gathering and analyzing current market information to reach an equitable settlement of damages for losses due to theft and collision, while maintaining good customer service and shop relations. • Confirms title status, researches any customizations, prior damage and condition. Identifies irregularities such as vehicles with salvage titles, grey market vehicles, custom/modified vehicles, and prior damage to determine their true market value. • Reviews DMV reports and identifies the correct transfer of ownership documents to send to the registered owner, secures lienholder payoff amounts and Letter of Guarantee. • Negotiates storage fees with body shops and towing yards. • Responds to written correspondence in a timely and efficient manner. Routes correspondence to Claims Document Processing to obtain correct paperwork when needed. • Stays updated on current vehicle values, industry and market trends, State licensing, and Company policy and procedures. • Contacts adjusters to confirm coverage, determine potential limits issues or possible fraudulent activity, and obtains approval to settle property damage. • Initiates contact with insureds/claimants or their representatives regarding total loss. • Completes and maintains comprehensive documentation of material damage information for assigned files and submits appropriate reports in a timely manner.

United States
$32.4K - $56.7K / year
Full TimeRemoteTeam 10,001+Since 1849H1B No Sponsor

• Deliver products to customers and sell additional products, including displays and endcaps, to maximize sales opportunities. • Develop and maintain strong relationships with existing and potential new customers, ensuring consistent communication and service excellence. • Plan and execute daily route schedules, visiting customers according to the weekly receiving sheet, and servicing all accounts as required. • Load products at the warehouse daily, maintain truck inventory, and manage inventory levels for assigned customers. • Adhere to safety, Fleet, and DOT policies; communicate daily with the District Manager (DM) regarding sales, potential opportunities, and operational updates. • Conduct routine inspections of the company vehicle and report any major maintenance issues to the DM. • Upload and communicate daily sales transactions using handheld equipment, ensuring timely and accurate reporting to the DM. • Ensure stores adhere to planograms (POGs) and maintain displays according to company guidelines. • Make end-of-day calls to the DM to report on completed activities, potential sales opportunities, and plans for the next day. • Perform other duties as assigned, including participation in store resets and special projects as needed.

South Carolina