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<h1>Customer Service - Customer Service Representative (M-F 11am-8pm) 105-1005</h1>   Tulsa, OK, USA Req #812   Sunday, June 1, 2025   <strong>JOB SUMMARY: <br><br></strong> Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will be customer focused, detail oriented and results driven. The most successful Customer Service Representatives demonstrate the following characteristics: polite, accurate, knowledgeable, able to work well within a team, learning agility, flexible and easily adapts to change.   <strong>KEY RESPONSIBILITIES: <br><br></strong>  <ul> <li>Process a high volume of incoming inquiries regarding multiple products from members, providers, billing companies, individuals with legal representation, employer groups, and other insurance companies. </li> <li>Strive to achieve first call resolution by communicating accurate information efficiently and timely thereby creating a positive experience for the member.</li> <li>Verifies eligibility, benefits, deductible amounts, claim status, copays, coinsurance and all other information related to a customer and their benefits or a provider and their contract. </li> <li>Use effective listening skills to understand the needs and complaints of the customer to offer them the best possible solution and ensuring the member feels supported and valued.</li> <li>Resolve escalated customer issues received from the member, provider, employer groups or brokers while remaining calm and professional.</li> <li>Provide interpretation services for all product lines via the contracted language line service as appropriate. </li> <li>Flexible hours, including weekends and evenings, as department or training needs dictate and at the discretion of management may be required.</li> <li>Effective problem resolution skills that demonstrates balance of company and customer needs.</li> <li>Demonstrated ability and learning agility to adapt to organizational changes including business processes, systems and technology.</li> <li>Joining a team of Customer Service Representatives and building a positive relationship of teamwork, trust, reliability and excellence.</li> <li>Understanding and striving to meet or exceed call center metrics while providing excellent customer service.</li> <li>Taking part in training and other learning opportunities to expand knowledge of company and position.</li> <li>Perform other duties as assigned.</li> </ul>  <strong>QUALIFICATIONS:</strong>  <ul> <li>Exceptional telephone manner, customer service skills, active listening skills, verbal and written communication skills.</li> <li>Ability to resolve conflict and diffuse tension</li> <li>Strong time management skills and decision- making skills.</li> <li>Ability to read, comprehend, and explain health insurance benefits in a clear, concise, and professional manner.</li> <li>Ability to work under stress with production and quality standards.</li> <li>Proficient in Microsoft Office applications.</li> <li>Highly organized and attentive to detail.</li> <li>Flexibility, ability to adapt to change.</li> <li>Successful completion of Health Care Sanctions background check.</li> <li>Bilingual skills a plus.</li> </ul>  <strong>EDUCATION/EXPERIENCE:</strong>  <ul> <li>High school diploma or equivalent required</li> <li>1-year customer service experience with direct interactions with customers</li> <li>Contact center or medical field experience preferred</li> </ul>        <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Hourly </li> </ul>    <a href="#"> Apply Now </a>

CommunityCare

Customer Service - Customer Service Representative (M-F 11am-8pm) 105-1005

<h1>Provider Services - Provider Services Representative (OKC or Tulsa) 115-1023</h1>   Oklahoma City, OK, USA ● Tulsa, OK, USA Req #788   Sunday, June 1, 2025   <p><strong>JOB SUMMARY:</strong></p> <p>Primarily responsible for contracting, orientation and ongoing education of physicians, physician office staffs, hospitals and other providers regarding the policies and procedures of CommunityCare Managed HealthCare Plans. Serves as the liaison between the provider community and the health plan.</p>  <p><strong>KEY RESPONSIBILITIES:</strong></p> <ul> <li>Conducts educational and credentialing PCP and appropriate SCP office site visits according to established standards. Provides ongoing education, develops agendas, organizes informational material, facilitates workshops and participates in meetings for assigned networks. Prepares regular correspondence and special mailings to assigned providers. </li> <li>Researches and responds to issues and inquiries concerning benefits, claims, reimbursement and member issues and recommends appropriate actions to the requesting party. Assist internal departments by contacting provider offices regarding customer service/operational issues/complaints &amp; grievance resolutions and documents appropriately. </li> <li>Coordinate internal process and procedure among departments to ensure network contract / operational procedures are appropriately reflected in our systems/processes. Participate in departmental processes established to ensure accurate and timely contracting, credentialing, loading and education of providers.</li> <li>Assist contracting in all phases of the Contracting process established by CommunityCare Managed Healthcare Plans of Oklahoma. Process may include communication with provider during negotiation through completion of executed document implementation of contract, and on-going contract deliverables. Participate in the development of networks and key geographical areas as needed.</li> <li>Participates in special projects and assignments as directed, including the development of new/improved operating procedures.</li> <li>Job may contain dimensions that could affect performance of responsibility, which may involve dealing with members who are sensitive and/or emotional.</li> <li>Perform other duties as assigned.</li> </ul>  <p><strong>QUALIFICATIONS</strong>:</p> <ul> <li>Possess strong oral and written communication skills.</li> <li>Ability to monitor and assess rapidly changing information.</li> <li>Ability to think quickly and respond tactfully to sometimes difficult issues in dealing with providers.</li> <li>Successful completion of Health Care Sanctions background check.</li> <li>Proficient in Microsoft applications</li> <li>Must have a current driver’s license and insurance verification and reliable transportation.</li> </ul>  <p><strong>EDUCATION/EXPERIENCE: </strong></p> <ul> <li>Bachelor's degree required OR each year of work experience in a healthcare industry can be substituted for each year of college not completed.</li> <li>Two to three years of industry related experience in managed care, insurance, physician environment or related area.</li> <li>Customer Service and sales related experience preferred.</li> </ul>       <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Hourly </li> </ul>    <a href="#"> Apply Now </a>

Provider Services - Provider Services Representative (OKC or Tulsa) 115-1023

<h1>Customer Service - Customer Service Representative 105-1014</h1>   Tulsa, OK, USA Req #834   Tuesday, May 27, 2025   <strong>JOB SUMMARY: <br><br></strong> Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will be customer focused, detail oriented and results driven. The most successful Customer Service Representatives demonstrate the following characteristics: polite, accurate, knowledgeable, able to work well within a team, learning agility, flexible and easily adapts to change.   <strong>KEY RESPONSIBILITIES: <br><br></strong>  <ul> <li>Process a high volume of incoming inquiries regarding multiple products from members, providers, billing companies, individuals with legal representation, employer groups, and other insurance companies. </li> <li>Strive to achieve first call resolution by communicating accurate information efficiently and timely thereby creating a positive experience for the member.</li> <li>Verifies eligibility, benefits, deductible amounts, claim status, copays, coinsurance and all other information related to a customer and their benefits or a provider and their contract. </li> <li>Use effective listening skills to understand the needs and complaints of the customer to offer them the best possible solution and ensuring the member feels supported and valued.</li> <li>Resolve escalated customer issues received from the member, provider, employer groups or brokers while remaining calm and professional.</li> <li>Provide interpretation services for all product lines via the contracted language line service as appropriate. </li> <li>Flexible hours, including weekends and evenings, as department or training needs dictate and at the discretion of management may be required.</li> <li>Effective problem resolution skills that demonstrates balance of company and customer needs.</li> <li>Demonstrated ability and learning agility to adapt to organizational changes including business processes, systems and technology.</li> <li>Joining a team of Customer Service Representatives and building a positive relationship of teamwork, trust, reliability and excellence.</li> <li>Understanding and striving to meet or exceed call center metrics while providing excellent customer service.</li> <li>Taking part in training and other learning opportunities to expand knowledge of company and position.</li> <li>Perform other duties as assigned.</li> </ul>  <strong>QUALIFICATIONS:</strong>  <ul> <li>Exceptional telephone manner, customer service skills, active listening skills, verbal and written communication skills.</li> <li>Ability to resolve conflict and diffuse tension</li> <li>Strong time management skills and decision- making skills.</li> <li>Ability to read, comprehend, and explain health insurance benefits in a clear, concise, and professional manner.</li> <li>Ability to work under stress with production and quality standards.</li> <li>Proficient in Microsoft Office applications.</li> <li>Highly organized and attentive to detail.</li> <li>Flexibility, ability to adapt to change.</li> <li>Successful completion of Health Care Sanctions background check.</li> <li>Bilingual skills a plus.</li> </ul>  <strong>EDUCATION/EXPERIENCE:</strong>  <ul> <li>High school diploma or equivalent required</li> <li>1-year customer service experience with direct interactions with customers</li> <li>Contact center or medical field experience preferred</li> </ul>        <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Hourly </li> </ul>    <a href="#"> Apply Now </a>

Customer Service - Customer Service Representative 105-1014

<h1>Medical Management - Supervisor Utilization Management 145-4002</h1>   Tulsa, OK, USA Req #819   Tuesday, May 27, 2025   <h1>JOB SUMMARY:</h1> <p>Responsible for supervising and coordinating daily workflow and leadership of staff. Activities include developing operating procedures and managing personnel and resources.</p>  <h1>KEY RESPONSIBILITIES:</h1> <ul> <li>Serves as a resource to the department staff by providing technical direction and resolving workflow problems or improvement opportunities within the department.</li> <li>Assesses individual workload and staffing patterns. Selects, assigns, and evaluates personnel, and recommends or initiates associated personnel actions. Takes caseload as needed to assist with staffing needs. Ensure authorization timeframes and regulatory requirements are met.</li> <li>Interviews, hires, trains, and reviews all eligibility personnel in addition to problem-solving and disciplinary actions. Participates in analysis of current policies and procedures and in the development of new or updated standard operating procedures and workflows.</li> <li>Attends departmental, interdepartmental, and facility meetings as needed.</li> <li>Performs other duties as assigned.</li> </ul> <h1>QUALIFICATIONS:</h1> <ul> <li>Ability to plan, organize, schedule, and effect procedural changes.</li> <li>Ability to effectively lead, direct and supervise others.</li> <li>Ability to reason logically and to use good judgment when interpreting materials or situations.</li> <li>Ability to work quickly and accurately with quantitative information.</li> <li>Ability to organize time effectively and set priorities.</li> <li>Possess strong written and oral communication skills.</li> <li>Proficient in Microsoft applications.</li> <li>Knowledge of managed care and benefit plans.</li> </ul> <h1>EDUCATION/EXPERIENCE:</h1> <ul> <li>Graduate from accredited School of Nursing.</li> <li>Current, active, unrestricted license to practice as Registered nurse (RN) in the State of Oklahoma.</li> <li>At least three years of clinical nursing experience in an acute care setting.</li> <li>2 years of management experience preferred.</li> </ul>       <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul>    <a href="#"> Apply Now </a>

Medical Management - Supervisor Utilization Management 145-4002

<h1>Senior Center - Manager Community Center 171-5001</h1>   Tulsa, OK, USA Req #787   Sunday, May 25, 2025   <p><strong>JOB SUMMARY:</strong></p> <p>Responsible for the overall management and operation of the community center, including oversight of staff and volunteers, budget development and management, program development, and ensuring the center's safety and upkeep. Assumes key role in community engagement, building relationships with local organizations, and promoting the center's services.</p> <p><strong>KEY RESPONSIBILITIES:</strong></p> <ul> <li> Oversight of daily operations: talent acquisition and scheduling of staff and volunteers, operational effectiveness, and ensuring the Community Center is clean, safe, and properly functioning. Build relationships with community members and act as a point of contact for Community Center members and visitors, address their concerns, and provide excellent customer service. Network with other organizations to identify potential partnerships. Represent the center at community events and meetings. Coordinate Senior Center clinics, seminars, education programs and meetings. Plan and submit schedules/calendars to the Corporate Communications Coordinator for the following month on the first day of the month. Travel may be required.</li> <li> Develop and implement financial forecasting and budget adherence  </li> <li> Hire, train, and supervise staff to ensure efficient and effective service delivery.  Oversee the performance management process, including setting performance goals, conducting 1:1 rounding and performance feedback sessions, and implementing individual development plans to ensure staff are meeting performance standards and achieving success. Manage the handling of all CTMs, HICS, potential inadvertent PHI issues, good cause requests, and reporting associated with these processes. </li> <li> Address any incidents or issues that arise at the Community Center, including safety concerns and conflicts.  Conduct regular safety inspections to ensure compliance with regulations and standards.   </li> <li> Manage the center's supplies, equipment, and other resources.   </li> <li> Identify community needs to create programs and activities to meet those needs. Coordinate with local organizations and government agencies to build relationships in order to expand program offerings and services.   </li> <li>All other duties as assigned.</li> </ul>  <p><strong>QUALIFICATIONS</strong>:</p> <ul> <li>Strong communication, presentation and interpersonal skills.</li> <li> Leadership and team management abilities  </li> <li>Organizational and time management skills  </li> <li>Budgeting and financial management  </li> <li>Knowledge of community resources and needs  </li> <li>Ability to plan, implement, and evaluate programs and events  </li> <li>Familiarity with safety, accessibility, and compliance regulations  </li> <li>Highly organized and attentive to detail.  </li> <li>Ability to work effectively with personnel at various levels.  </li> <li>Proficiency in Microsoft suite   </li> <li>Successful completion of Healthcare Sanctions background </li> </ul>  <p><strong>EDUCATION/EXPERIENCE:</strong></p> <ul> <li>Bachelor's degree in Public Health Administration, Business Administration, or a related field is preferred. An equivalent mix of education and experience may also be considered.</li> <li> Two to five years relevant leadership experience in one of the following:   </li> </ul> <ul> <li> Community outreach or services  </li> </ul> <ul> <li> Program coordination or nonprofit work  </li> </ul> <ul> <li> Administrative leadership role  </li> </ul> <ul> <li> Possession of an appropriate valid driver's license and maintain an insurable driving record. (may need to drive to other locations/events)  </li> <li> Possession of or ability to obtain and maintain a certification in CPR and First Aid Certifications within six months from date of hire.  </li> </ul>        <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul>    <a href="#"> Apply Now </a>

Senior Center - Manager Community Center 171-5001

<h1>Medical Management - Utilization Management RN 145-2018</h1>   Tulsa, OK, USA Req #776   Friday, May 23, 2025   <p><strong>JOB SUMMARY: </strong></p> <p>Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team.</p> <p><strong>KEY RESPONSIBILITIES: </strong></p> <ul> <li>Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute services when indicated.</li> <li>Determines medical necessity and appropriateness of services using clinical review criteria.</li> <li>Accurately documents all review determinations and contacts providers and members according to established timeframes.</li> <li>Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director.</li> <li>Appropriately identifies and refers quality issues to Medical Management leadership.</li> <li>Appropriately identifies potential cases for Care Management programs.</li> <li>Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum.</li> <li>Performs accurate data entry.</li> <li>Communicates appropriate information to other staff members as necessary/required.</li> <li>Participates in continuing education initiatives.</li> <li>Collaborates with other departments as needed.</li> <li>Performs other duties as assigned.</li> </ul> <p><strong>QUALIFICATIONS: </strong></p> <ul> <li>Knowledge of managed care and associated group benefit plans.</li> <li>Possess strong oral and written communication skills.</li> <li>Ability to reason logically and to use good judgment when interpreting materials or situations.</li> <li>Knowledge of community- based resources.</li> <li>Must have excellent organizational skills and be able to perform multiple tasks.</li> <li>Proficient in Microsoft applications.</li> <li>Excellent time management and documentation skills.</li> <li>Successful completion of Health Care Sanctions background check. </li> </ul> <p><strong>EDUCATION/EXPERIENCE: </strong></p> <ul> <li>Graduation from accredited School of Nursing.</li> <li>Current, active, unrestrictive license to practice as a Registered Nurse in the State of Oklahoma.</li> <li>Three years of acute care experience preferred.</li> <li>Two years of experience working with population health preferred.</li> <li>Previous discharge planning or case management experience preferred.</li> <li>Managed care experience a plus.</li> </ul>       <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul>    <a href="#"> Apply Now </a>

Medical Management - Utilization Management RN 145-2018

<h1>Quality Improvement - QI Stars Specialist_195-2016</h1>   Tulsa, OK, USA Req #751   Tuesday, May 20, 2025   <p><strong>JOB SUMMARY:</strong></p> <p>The Quality Improvement Stars Specialist is an integral part of the team, focusing on enhancing the performance of quality programs. This role requires a proactive individual who is adept at working collaboratively with provider groups and multidisciplinary teams with minimal oversight to ensure adherence to deadlines and compliance with regulatory requirements. The specialist will play a pivotal role in the analysis, development, and implementation of strategies aimed at improving Star Ratings. Included in this is the responsibility for managing and analyzing data from various surveys to drive process improvements and enhance the quality of care for our members. </p>  <p><strong>KEY RESPONSIBILITIES:</strong></p> <ul> <li>Monitor and analyze Star Ratings performance metrics to identify areas for improvement. </li> </ul> <ul> <li>Develop and maintain detailed reports on Star Ratings performance, trends, and forecasts. </li> </ul> <ul> <li>Plans, organizes, executes, and finishes assigned projects associated with program scope. </li> </ul> <ul> <li>Complies data and prepares reports for other program work related to State, Federal, and Accreditation requirements. </li> </ul> <ul> <li>Develop and maintain strong relationships with provider groups to foster collaboration and engagement in improving quality measures and patient outcomes. </li> </ul> <ul> <li>Coordinate the administration of CAHPS, QHP, and HOS surveys, ensuring timely and accurate data collection and submission. </li> </ul> <ul> <li>Monitor survey processes to maintain high response rates and data integrity. </li> </ul> <ul> <li>Analyze survey data to identify trends, strengths, and areas for improvement. </li> </ul> <ul> <li>Generate reports and dashboards to present findings to stakeholders. </li> </ul> <ul> <li>Present findings to senior management and stakeholders, providing actionable recommendations. </li> </ul> <ul> <li>Provide training and support to provider groups on best practices for achieving high Star Ratings. </li> </ul> <ul> <li>Supports the overall department goals and objectives, including back-up support for various departmental functions. </li> </ul> <ul> <li>Evaluate the effectiveness of quality improvement initiatives and make necessary adjustments. </li> </ul> <ul> <li>Collaborate with cross-functional teams to develop and implement quality improvement initiatives based on survey results. </li> </ul> <ul> <li>Track and evaluate the effectiveness of implemented changes. </li> </ul> <ul> <li>Ensure compliance with all CMS regulations and guidelines related to Medicare Advantage Star Ratings. Keep abreast of changes in Stars Rating program and updates internal processes accordingly. </li> </ul> <ul> <li>Assists with staff orientation, training, and re-training on program work requirements as indicated. </li> </ul> <ul> <li>Perform other duties as assigned. </li> </ul> <p></p> <p><strong>QUALIFICATIONS:</strong></p> <ul> <li>Minimum of 3-5 years of experience in healthcare quality improvement or a related role. </li> </ul> <ul> <li>Strong understanding of Medicare Advantage Star Ratings and CMS guidelines. </li> </ul> <ul> <li>Excellent analytical, organizational, and communication skills. </li> </ul> <ul> <li>Ability to work independently and as part of a team. </li> </ul> <ul> <li>Ability to manage multiple tasks simultaneously, work independently with minimal supervision, and meet stringent deadlines. </li> </ul> <ul> <li>Demonstrates strong organizational skills and is attentive to details. </li> </ul> <ul> <li>Possess strong oral and written communication skills. </li> </ul> <ul> <li>Strong familiarity with managed care and healthcare terminology. </li> </ul> <ul> <li>Successful completion of Health Care Sanctions background check. </li> </ul> <p></p> <p><strong>EDUCATION/EXPERIENCE:</strong></p> <ul> <li>(Preferred) Bachelor’s degree in healthcare administration, Public Health, Statistics, or a related field. </li> </ul> <ul> <li>Associates degree and/ or 3 years of experience in quality, benefit plans, claims, customer services, quality improvement, medical management, or similar healthcare operations. </li> </ul>       <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul>    <a href="#"> Apply Now </a>

Quality Improvement - QI Stars Specialist_195-2016

<h1>Provider Services - Supervisor Provider Contracting 115-4000 </h1>   Tulsa, OK, USA Req #765   Sunday, May 18, 2025   <p><strong>JOB SUMMARY:</strong></p> <p>Responsible for the negotiation, execution and implementation of all HMO, PPO and Government Programs, provider contracts including value based and complex. Responsible for the supervision (planning, execution, implementing and monitoring) of all aspects of the provider contracting staff. Responsible for contract related processes and procedures under the direction of the Director, Provider Relations. Responsible for ensuring provider contracting is performed in compliance with all regulatory requirements and accreditation standards.</p>  <p><strong>KEY RESPONSIBILITIES:</strong></p> <ul> <li>Supervises and facilitates contract negotiations, contract document processes and ongoing deliverables for provider contracts for all assigned product lines as directed by Director, Provider Relations in accordance with all regulatory requirements and accreditation standards. Responsible for oversight of production, documentation, audit, implementation, and ongoing contract deliverables related to contracting process. Ongoing assessment of resource allocation to ensure that the process is working as designed with continual awareness of process improvement opportunities. Operationalize contract related projects assigned by Director, Provider Relations.</li> <li>Facilitates and coordinates all value based and complex provider contracting according to and within company guidelines as directed by the Director, Provider Relations. Facilitates reimbursement analysis and recommends provider reimbursement mechanisms. Assists with development of network contracting models including capitation allotment and value-based incentive mechanisms. Develops financial and utilization review report requests. Responsibilities include accurate document development, coordinating with Management and provider, accurate and prompt implementation of all aspects of owned contracts.</li> <li>Supervision and development of contracting staff. Participates in the hiring process. Trains, assigns tasks and supports continuing professional development. Evaluate performance and recommend needed personnel actions. Document appropriately. Monitor staffing needs and workflow and recommend changes as needed. Distribute information to subordinates appropriately and in a timely manner to facilitate their job needs. Delegate tasks/projects appropriately to promote personal growth. Model and promote behavior supportive of a teamwork concept.</li> <li>Participate in the development of new and existing provider networks to ensure appropriate access and availability for all enrolled lives. Participate in assessing requests and initiating requests for addition of services and providers for all product lines. Participates in the assessment of access and availability of services. Support organizational and departmental goals and objectives related to securing appropriate network panels and budget sensitive reimbursement through timely response to administrative and departmental contract requests and projects.</li> <li>Support business operations. Attend information and implementation meetings. Communicate information interdepartmentally and follow through on required action items. Communicate trends and specific incidents impacting company risk management to the appropriate parties. Design and implement policies and procedures contributing to improved efficiency. Monitor departmental compliance to accreditation and regulatory agencies and adjust staffing, policies and procedures as needed. Participate in special projects.</li> </ul> <p></p> <p></p> <p><strong>QUALIFICATIONS:</strong></p> <ul> <li>Ability to process and understand complex information. Ability to organize and oversee multiple complex tasks/projects to completion.</li> <li>Ability to coordinate resources in an effective, cost-efficient manner.</li> <li>Excellent communication and interpersonal skills.</li> <li>Ability to interpret and communicate detailed technical and financial information.</li> <li>Demonstrated knowledge of physician and hospital capitation reimbursement methodologies.</li> <li>Familiarity with healthcare and managed care business operation environments.</li> <li>Strong familiarity with managed care terminology.</li> <li>Proficiency with software systems including Amisys, Microsoft Word and Excel.</li> <li>Ability to converse and write fluently in English.</li> </ul> <p></p> <p><strong>EDUCATION/EXPERIENCE:</strong></p> <ul> <li>Bachelor’s degree plus 3 years work related experience.</li> <li>Supervisory experience required.</li> <li>Demonstrate through past performance and progressive increased in responsibility, the ability to accomplish goals.</li> <li>Excellent oral presentation and writing skills.</li> <li>Previous physician/hospital contracting, claims processing, or reimbursement development and auditing experience.</li> <li>Familiarity with providers and provider issues in a managed care environment.</li> <li>Previous claims software experience, preferably Amisys.</li> </ul>       <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul>    <a href="#"> Apply Now </a>

Provider Services - Supervisor Provider Contracting 115-4000

<h1>Information Technology - Senior Programmer Analyst 130-2009</h1>   Tulsa, OK, USA Req #761   Sunday, May 18, 2025   <p><strong>JOB SUMMARY: </strong></p> <p>Focus on the development and support of new and existing Database Management Systems (DBMS). Responsible for the design, development and implementation of new applications as well as maintaining and updating existing programs. <br> </p> <p><strong>KEY RESPONSIBILITIES: </strong></p> <ul> <li>Perform Oracle DBA Functions</li> <li>Design and analysis of critical Database Management Systems (DBMS) related to the AMISYS systems and surround code programs.</li> <li>Design, code, test, maintain and document structured desktop and web programs using various applications software. Take written program specifications and develop working applications to be implemented for the end-users.  </li> <li>Work with end-users to determine their specific requirements and needs. Document those requirements and develop written program specifications from them. Maintain and update existing applications as needed or requested by end-users.  </li> <li>Train end-users on newly developed and existing applications.</li> <li>Required to be on call 24/7. May be contacted by phone or email. May receive up to 3 to 4 calls per week.</li> <li>Perform other duties as assigned.</li> </ul> <p><strong>QUALIFICATIONS</strong>:</p> <ul> <li>Skills in project management.</li> <li>Understanding of mathematical concepts and skills in abstract reasoning.</li> <li>Successful completion of Health Care Sanctions background check.</li> <li>Proficient in personal computer applications, Windows/Client Server programming languages, and database design.</li> <li>Excellent problem solving and organizational skills.</li> <li>Ability to communicate technical information to users in concise understandable terms.</li> <li>Ability to work as a team member in a high paced environment.</li> <li>Must be able to maintain and preserve information of a highly confidential nature.</li> <li>Ability to converse and write fluently in English.</li> </ul> <p><strong>EDUCATION/EXPERIENCE: </strong></p> <ul> <li>Bachelor’s degree, Masters degree preferred.</li> <li>5 years related systems experience. Project management experience preferred.</li> </ul>       <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul>    <a href="#"> Apply Now </a>

Information Technology - Senior Programmer Analyst 130-2009

<h1>Enrollment Services - Reconciliation Specialist 160-1012</h1>   Tulsa, OK, USA Req #803   Sunday, May 18, 2025   <p><strong>JOB SUMMARY: </strong></p> <p>Ensure integrity of member enrollment data and investigate and resolve complex and exception errors. Duties include identifying potential changes in eligibility, seeking verification of changes and disseminating enrollment information to complete the reconciliation.</p> <p></p> <p><strong>KEY RESPONSIBILITIES: </strong></p> <ul> <li>Monitors accounts receivable balances by comparing payment/adjustment reports to eligibility (both CMS &amp; CCOK) to identify discrepancies by member.  </li> <li>Prepare discrepancy reports for each account, communicating directly with the various contact for verification. Maintaining the files for each account, both the hard copies and electronic copies.</li> <li>Coordinates interdepartmental personnel involved in creating billing transactions to reflect the discrepancies verified as actual terminations, enrollments or premium changes. Verifying that transactions documented to be made were made by the appropriate persons.</li> <li>Performs other duties as assigned.</li> </ul> <p></p> <p><strong>QUALIFICATIONS: </strong></p> <ul> <li>Must possess strong working knowledge of accounting principles.</li> <li>Proficient in Microsoft applications.</li> <li>Ability to work on multiple projects concurrently.</li> <li>Strong problem solving &amp; critical thinking skills.</li> <li>Possess strong oral and written communication skills.</li> <li>Successful completion of Health Care Sanctions background check.</li> </ul> <p><strong>EDUCATION/EXPERIENCE: </strong></p> <ul> <li>High school diploma or equivalent; Associate degree preferred.</li> <li>One to three years of previous working experience in accounting, benefits or similar function; preferably in a healthcare environment.</li> </ul>       <p>CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Hourly </li> </ul>    <a href="#"> Apply Now </a>

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