Trabajos emblemhealth en Bayonne, New JerseyCrear alertas

Summary: We are seeking a hands-on Medicare Actuary to support pricing, forecasting, and bid development for Medicare Advantage (MA), Part D, and EGWP products. This role will support end-to-end bid season execution, Medicare forecasting, and deliver deep experience analytics to inform pricing, product strategy, and financial performance. The ideal candidate combines Medicare bid expertise, experience study rigor, and a builder mindset to improve processes, and elevate insights. Key Responsibilities: Bid & Pricing (MA/Part D/EGWP) • Own actuarial components of the annual Medicare Advantage and Part D bids, including benefit pricing, trend, risk score assumptions, admin load, and margins., • Be a collaborative partner across teams by pricing product scenarios., • Review ongoing CMS releases and refine assumptions to monitor a rapidly changing landscape. Forecasting • Deliver regular forecasting with clear drivers, risks, and variances vs. plan/budget. Requirements: • Bachelor’s degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required, • Associate of the Society of Actuaries (ASA) required, • 5 – 8+ years relevant professional work experience and/or education required, • 4+ years health insurance actuarial experience, preferably in the managed care industry required, • Prior management experience (processes and/or staff) preferred, • A comprehensive understanding of actuarial principles and methodologies; strong mathematical and analytical skills required, • Ability to communicate effectively with Business leaders required, • Expert level skills with database, spreadsheet, and analytical software required, • Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook, Teams, etc.) required, • Strong data querying skills using tools such as SQL or SAS Enterprise Guide preferred, • Capable with data extraction, simulations, automation required

Identify customer needs and help solve customer issues related to health plans, health and wellness and enrollment within regulatory guidelines; providing direct guidance or identifying other EmblemHealth (EH) and community resources to find customer solutions, conduct customer needs assessment, edu

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area.With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our servic

We are seeking an Endocrinology trained physician to join our multispecialty group in pursuit of high quality patient care to provide full scope Endocrinology services. One to three years of endocrinology clinical experience in an outpatient setting. Ability to diagnose and treat a wide variety of e

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area.With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our servic

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area.With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our servic

We are seeking an experienced Internal or Family Medicine trained physician to join us in pursuit of high-quality patient care to provide a full scope of primary care services including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance. Internal Me

EmblemHealth is seeking a Clinical Reviewer in New York to perform clinical reviews and ensure accurate administration of benefits.

We are seeking an experienced Internal or Family Medicine trained physician to join us in pursuit of high-quality patient care to provide a full scope of primary care services including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance. Internal Me

Ensure that the team executes on all elements required to maximize member satisfaction, with a focus on increasing retention, and coordinating member needs from areas such as Quality and Care Management; member needs include closing care gaps, getting HRAs completed, enrolling in care management pro

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area.With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our servic

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area.With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our servic

EmblemHealth is seeking a Contract Configuration Specialist in New York to manage Professional, Facility, and Ancillary contracts. This role involves collaborating with Network Development, Analytics, and ensuring the accuracy of contract loads within the claims reimbursement cycle.

We are seeking an experienced Internal or Family Medicine trained physician to join us in pursuit of high-quality patient care to provide a full scope of primary care services including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance. AdvantageCa

EmblemHealth is seeking a qualified professional to support the eligibility and benefits configuration process, ensuring quality assurance and implementing client pharmacy benefit designs.This role involves collaboration with various teams to enhance member experience through accurate benefit admini

This role requires expertise in cloud platforms, a strong background in IT systems engineering, and a focus on security measures to protect cloud environments. A healthcare company is looking for a skilled professional to lead the design, deployment, and maintenance of cloud infrastructure and servi

EmblemHealth in New York, NY is seeking a leader for Pharmacy Account Management, responsible for overseeing Pharmacy Account Manager teams and implementing strategic product initiatives.

Applicants should have extensive experience in data analytics within a healthcare setting and must possess strong communication and technical skills.

Summary of JobLead and Direct Pharmacy Account Management for the enterprise, including managing and leading Pharmacy Account Manager(s) and Clinical Pharmacy Account Manager(s) for both pharmacy direct clients as well as shared clients with Product and City Account Management Teams. QualificationsB

Business Operations, Information Systems or equivalentMaster's Degree (Preferred)Minimum 2-3 years of relevant experience, preferably in a health care environment (Required)Strong familiarity with EmblemHealth's claims systems and interdependent applications (Required)Experience in provider, facilit

Customer Service Representative.Work closely with onsite sales colleagues to identify customers in need of enrollment services and provide post sales customer service follow-up.Interact face-to-face with customers, assisting in providing complete resolution of customer concerns including claims, ben

Serve as claim processing subject matter expert for resolution of issues related to claims processing and adjudication outcomes for medical, hospital, dental claims for all EmblemHealth lines of business as requested by EmblemHealth business partners or CTS business partners. Claims Processing Subje

Qualifications RN required, with current active RN license (Required) CCM certification (Preferred) Certification in utilization or care management (Preferred) 4 – 6 years of clinical experience (Required) Certified Diabetes Care and Education Specialist (CDCES) designation and experience (Re

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area.With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our servic

EmblemHealth seeks a Registered Nurse to provide nursing care and support a patient care team in New York.

EmblemHealth in New York seeks a Clinical Account Manager to manage client relationships and provide expertise in pharmacy benefits.

Summary of Job Provide care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members' health care needs, identifying gaps in care and needed support, administering/coordinating implementation of interventions

Summary of Position Perform clinical reviews within the Medical Management Operations Concurrent Review utilization management department.Ensure accurate administration of benefits, execution of clinical policy and timely access to appropriate levels of care.Principal Accountabilities Under the dir

Responsible for the daily operation, maintenance, and organization of EmblemHealth's Community Outreach Vehicles (COVs), cargo vans, and RVs at assigned marketing locations.