Job Title Leads and manages team responsible for configuration activities including accurate and timely implementation and maintenance of critical information on claims databases, validation of data stored on databases, and adherence to health plan business and
Dental Clinical Reviewer Provides support and subject matter expertise for member clinical dental review activities. Responsible for determining appropriateness and medical necessity of member dental care services - targeting opportunities for quality improvement and satisfaction for
Job Title Performs research and analysis of complex healthcare claims data, pharmacy data, and contract data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and operations reports and makes recommendations based