49 jobs found in louisiana

Vantage Health Plan, Inc. was formed in 1994 as a result of a conversation between a practicing physician, now our president and CEO, and his neighbor regarding the lack of quality and affordable healthcare options in our area. Today, Vantage covers nearly 40,000 members throughout Louisiana and is now expanding into neighboring states. We remain committed to proactively seeking opportunities to improve the quality of healthcare while balancing the cost of that care and pride ourselves in providing friendly, compassionate, and local customer service to our members. Vantage offers competitive salaries and excellent benefits including Health and Dental coverage, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k). Vantage is currently seeking a Provider Relations Representative to maintain our provider network in the Mississippi Gulf Coast territory. **Additional earnings opportunities are available through internal incentive program**...

Gallagher is a global leader in insurance, risk management and consulting services. We help businesses grow, communities thrive and people prosper. We live a culture defined by The Gallagher Way, our set of shared values and guiding tenets. A culture driven by our people, over 30,000 strong, serving our clients with customized solutions that will protect them and fuel their futures. We are seeking a Client Service Manager to join our growing team. Can you deliver exceptional customer service? Are you interested in helping a range of clients through issues that vary from relatively simple to moderately complex? We are looking for people who are passionate about building relationships with clients, will collaborate with the sales team to achieve goals, constantly seek improvement and will demonstrate the value Gallagher can provide. How will you affect the business? Take a leadership role in the renewal process to ensure the best possible solutions are delivered to...

Gallagher is a global leader in insurance, risk management and consulting services. We help businesses grow, communities thrive and people prosper. We live a culture defined by The Gallagher Way, our set of shared values and guiding tenets. A culture driven by our people, over 30,000 strong, serving our clients with customized solutions that will protect them and fuel their futures. We are seeking a Client Service Manager to join our growing team. Can you deliver exceptional customer service? Are you interested in helping a range of clients through issues that vary from relatively simple to moderately complex? We are looking for people who are passionate about building relationships with clients, will collaborate with the sales team to achieve goals, constantly seek improvement and will demonstrate the value Gallagher can provide. How will you affect the business? Take a leadership role in the renewal process to ensure the best possible solutions are delivered to...

At Vantage Health Plan , we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k). Vantage Health Plan is currently looking for a Medical Management Inpatient RN.*remote opportunity - must live in LA,MS, AR* Job Summary: The Medical Management Inpatient RN is directly involved within the Medical Management (Utilization Review) program of Vantage Health Plan and assures the delivery of medically necessary, quality patient care through appropriate utilization of resources in a cost effective and timely manner. The Medical Management IP Nurse is an intricate part of this program by utilizing Vantage’s authorization system to review and approve services based upon Standardized Criteria, Health Plan Medical Policy and Clinical Guidelines and the local delivery systems. Each...

At Vantage Health Plan, Inc , we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k). Vantage is currently looking for a Quality Improvement Risk Adjustment Retrieval Specialist to work at our Baton Rouge location from 8:00AM – 5:00PM, Monday through Friday. Job Summary: The Quality Improvement Retrieval Specialist is responsible for medical record chart retrieval between Blue Cross Blue Shield of Louisiana (BSBSLS) and medical services providers as well as performing Quality Assurance (QA) reviews and medical records per CMS, HHS, protocol, and NCQA guidelines. This position is accountable for complying with all laws, regulations, and accreditation standards that are associated with duties and responsibilities. Essential Duties &...

At Vantage Health Plan, Inc ., we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k). Vantage is currently looking for a Medical Management Inpatient RN to work at our downtown Monroe location from 8:00AM – 5:00PM, Monday through Friday.  Job Summary: The Medical Management Inpatient RN is directly involved within the Medical Management (Utilization Review) program of Vantage Health Plan and assures the delivery of medically necessary, quality patient care through appropriate utilization of resources in a cost effective and timely manner. The Medical Management IP Nurse is an intricate part of this program by utilizing Vantage’s authorization system to review and approve services based upon Standardized Criteria, Health Plan Medical Policy and Clinical Guidelines and...

Vantage Health Plan, Inc ., we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k). Job Summary: The Medical Management Appeals Specialist in the Case Management Division is responsible for researching and preparing assigned appeals that have potential for secondary and external review. Essential Duties & Responsibilities: • Responsible for handling assigned appeals based on the following: All Member appeals for all lines of business. All Medicare provider appeals from non-contracted providers. • Research and prepare all qualifying appeals for review. This includes the gathering and case formatting but is not limited to: Research of CMS and VHP policy for claim processing, covered benefits, allowed services, internal decision history, internal claim...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) Positions in this function are accountable for the full range of provider relations and service interactions within UHG, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to...

Job Summary: The Provider Information Specialist is responsible for credentialing new providers and accurately loading their data into Vantage’s system as well as re-credentialing existing network providers timely and in accordance with federal and state regulations and standards including the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). The Provider Information Specialist is also responsible for maintaining existing providers and submitting the necessary updates and requests to ensure Vantage’s provider data is accurate and up to date. Essential Duties & Responsibilities: • Track and maintain credentialing process through VNet and QNXT on a daily basis • Utilize credentialing checklist module according to provider type to ensure all required provider information is received • Review state approved provider applications and supporting documents for accuracy and completeness, verifying...

Vantage Health Plan, Inc. was formed in 1994 as a result of a conversation between a practicing physician, now our president and CEO, and his neighbor regarding the lack of quality and affordable healthcare options in our area. Today, Vantage covers nearly 40,000 members throughout Louisiana and is now expanding into neighboring states. We remain committed to proactively seeking opportunities to improve the quality of healthcare while balancing the cost of that care and pride ourselves in providing friendly, compassionate, and local customer service to our members. Vantage offers competitive salaries and excellent benefits including Health and Dental coverage, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k). Vantage is currently seeking a Provider Relations Representative to maintain our provider network in the Mississippi Gulf Coast territory. **Additional earnings opportunities are available through internal incentive program**...

At Vantage Health Plan, Inc ., we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k). Vantage is currently looking for a Medical Management Inpatient RN to work at our downtown Monroe location from 8:00AM – 5:00PM, Monday through Friday.  Job Summary: The Medical Management Inpatient RN is directly involved within the Medical Management (Utilization Review) program of Vantage Health Plan and assures the delivery of medically necessary, quality patient care through appropriate utilization of resources in a cost effective and timely manner. The Medical Management IP Nurse is an intricate part of this program by utilizing Vantage’s authorization system to review and approve services based upon Standardized Criteria, Health Plan Medical Policy and Clinical Guidelines and...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) The Manager, Dental Network Advancement develops the provider network (dental) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management and produces an affordable and predictable product for customers and business partners. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with providers and ensures the network composition includes an appropriate distribution of provider specialties across all lines of business...

At Vantage Health Plan, Inc , we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k). Vantage is currently looking for a Quality Improvement Risk Adjustment Retrieval Specialist to work at our Baton Rouge location from 8:00AM – 5:00PM, Monday through Friday. Job Summary: The Quality Improvement Retrieval Specialist is responsible for medical record chart retrieval between Blue Cross Blue Shield of Louisiana (BSBSLS) and medical services providers as well as performing Quality Assurance (QA) reviews and medical records per CMS, HHS, protocol, and NCQA guidelines. This position is accountable for complying with all laws, regulations, and accreditation standards that are associated with duties and responsibilities. Essential Duties &...

Gallagher is a global leader in insurance, risk management and consulting services. We help businesses grow, communities thrive and people prosper. We live a culture defined by The Gallagher Way, our set of shared values and guiding tenets. A culture driven by our people, over 30,000 strong, serving our clients with customized solutions that will protect them and fuel their futures. Key Responsibilities: Acts as an advocate for most complex clients and claims, demonstrating advanced problem resolution skills and the ability to manage and communicate issues for key accounts by providing coverage advice to clients. Reviews coverage positions and challenges adjusters as warranted while advocating the best possible outcome for clients in accordance with service standards. Facilitates client meetings, claims reviews and vendor visits. Responsible for negotiating changes in reserves for a positive client outcome, providing status reports to clients as required by any...

Vantage Health Plan, Inc ., we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k). Job Summary: The Medical Management Appeals Specialist in the Case Management Division is responsible for researching and preparing assigned appeals that have potential for secondary and external review. Essential Duties & Responsibilities: • Responsible for handling assigned appeals based on the following: All Member appeals for all lines of business. All Medicare provider appeals from non-contracted providers. • Research and prepare all qualifying appeals for review. This includes the gathering and case formatting but is not limited to: Research of CMS and VHP policy for claim processing, covered benefits, allowed services, internal decision history, internal claim...

Gallagher is a global leader in insurance, risk management and consulting services. We help businesses grow, communities thrive and people prosper. We live a culture defined by The Gallagher Way, our set of shared values and guiding tenets. A culture driven by our people, over 30,000 strong, serving our clients with customized solutions that will protect them and fuel their futures. Position Summary: Acts as an advocate for complex clients, providing assistance and coverage advice as well as monitoring of large and complex claims, documenting all pertinent activity as it relates to the claim. Key responsibilities: Consulting with clients and brokers on claims and coverage issues; Facilitating and attending client meetings and claims reviews; and Negotiating changes in reserves for a positive client outcome as appropriate by line of coverage. Provides status reports to clients as required by any applicable service plan, reviews action plans and reserves with...

Gallagher is a global leader in insurance, risk management and consulting services. We help businesses grow, communities thrive and people prosper. We live a culture defined by The Gallagher Way, our set of shared values and guiding tenets. A culture driven by our people, over 30,000 strong, serving our clients with customized solutions that will protect them and fuel their futures. The Personal Lines Client Service Manager II, reporting to the Private Client Services Supervisor, acts as primary contact for High Net Worth clients and is responsible for the overall management of their personal insurance program. This role is responsible for staying abreast of changes in clients' lifestyle that impact their risk profile and coverages, conducting annual reviews of clients' insurance program, negotiating with carriers on client's behalf based on detailed market knowledge, and recommending appropriate coverages, limits and risk management solutions to clients. In addition, this...

Gallagher is a global leader in insurance, risk management and consulting services. We help businesses grow, communities thrive and people prosper. We live a culture defined by The Gallagher Way, our set of shared values and guiding tenets. A culture driven by our people, over 30,000 strong, serving our clients with customized solutions that will protect them and fuel their futures. We are seeking a Client Service Manager to join our growing team. Can you deliver exceptional customer service? Are you interested in helping a range of clients through issues that vary from relatively simple to moderately complex? We are looking for people who are passionate about building relationships with clients, will collaborate with the sales team to achieve goals, constantly seek improvement and will demonstrate the value Gallagher can provide. How will you affect the business? Take a leadership role in the renewal process to ensure the best possible solutions are delivered to...

Gallagher is a global leader in insurance, risk management, and consulting services. We help businesses grow, communities thrive, and people prosper. We live by The Gallagher Way, our set of shared values and guiding tenets. Our culture, driven by our people, over 35,000 strong, serves our clients with customized solutions that will protect them and fuel their futures. We are proud to be recognized by Forbes as a Best Employer for Diversity, be one of the Human Rights Campaign Foundation's Best Places to Work for LGBTQ+ Equality and named one of the World's Most Ethical Companies by Ethisphere for the 11th consecutive year. This is a place to learn, grow and succeed The Achieve Program is a structured learning and development program perfect for recent graduates or those looking to transition to a new career. We provide the foundation for building industry knowledge, skills, and expertise. You bring your passion for fast-tracking your career from a Client Service Associate...

Gallagher is a global leader in insurance, risk management and consulting services. We help businesses grow, communities thrive and people prosper. We live a culture defined by The Gallagher Way, our set of shared values and guiding tenets. A culture driven by our people, over 30,000 strong, serving our clients with customized solutions that will protect them and fuel their futures. We are seeking a Client Service Manager to join our growing team. Can you deliver exceptional customer service? Are you interested in helping a range of clients through issues that vary from relatively simple to moderately complex? We are looking for people who are passionate about building relationships with clients, will collaborate with the sales team to achieve goals, constantly seek improvement and will demonstrate the value Gallagher can provide. How will you affect the business? Take a leadership role in the renewal process to ensure the best possible solutions are delivered to...