Professional I, Service Delivery Healthcare

Conduent Boca Raton , FL 33427

Posted 1 week ago

Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.

We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.

Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com.

Purpose:

  • Responsible for providing professional and analytical support to medical services programs, including implementation, operation and contract compliance (e.g., Medicare); Utilization Review; Condition Management; Health Care Coordination; Case Management; Insurance Claim Administration; Pharmacy Services; Medical Services; Collection Services; Negotiates liability settlement of medical claims with third parties or healthcare providers; seeks reimbursement from healthcare providers and/or ensures payment of claims by appropriate insurance carrier.

Scope:

General:

  • Builds knowledge of the organization, processes and customers

  • Requires knowledge and experience in own discipline; still acquiring higher level knowledge and skills

  • Receives a moderate level of guidance and direction

  • Moderate decision making authority guided by policies, procedures, and business operations protocol

Primary Responsibilities:

  • May perform one or more of the following:

  • Reviews patient prescription history and identifies possible safety or conflict issues. Communicates findings to treating physician.

  • Provides professional and analytical support focusing on the analysis, program development and evaluation of applicable medical services offerings (including medical, dental and pharmaceutical).

  • Analyzes existing medical, dental and pharmacy plans to ensure performance measures are being met; makes recommendations on methods for improvement.

  • Develops applicable utilization reports focusing on pharmaceutical, dental and medical plan usage; provides analyses and recommendations based on findings.

  • Provides professional/analytical support to applicable medical services programs including implementation, operation and contract compliance (e.g. Medicare/Medicaid program).

  • Ensures company compliance with federal and state laws

  • All other duties as assigned

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. '1904593


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Professional I, Service Delivery Healthcare

Conduent