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Insurance/Healthcare Consultant

Company: Cosmos IT Solutions
Location: West Sacramento
Posted on: June 22, 2020

Job Description:

Location West Sacramento, CA Work must be performed in State of California The InsuranceHealthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider appeals and meets with providers to resolve problemsissues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs Responsibilities bull Participates, coordinates and leads in the identification, documentation, analysis and validation of advanced business processes, systems, and solution requirements. bull Leads the research, evaluation and design components of complex solutions to problems. bull Provides expertise and guidance to support requirements of large cross- functional initiatives and projects, while contributing to the development and techniques used to meet the requirements of the business unit. bull Develop strategies and provide leadership toward the analysis, information validation, and decision- making process in a team environment, while ensuring cross-functional requirementsneeds are met. bull Provides leadership and facilitates process improvements that cross functional business units and ensure customer satisfaction. bull Manage multiple assignments with no supervision. Education and Experience Required bull Bachelor's degree in healthcare or related field. bull Must have current certification and licensing in area of expertise. May hold advanced certification in work field. bull Typically minimum of 12+ years of relevant experience with Bachelor's degree. bull Typically, 12+ years of working experience. bull Must possess current certification, including necessary licenses, for the field of specialty. (as required) Knowledge and Skills bull Experience with expert knowledge of commercial and government insurance programs. bull Extensive level of understanding and application of healthcare related technologies. bull Experience leading large projects, managing the implementation of a new expanded business process, interpreting research, and providing complex problem resolution. bull Demonstrated leadership ability. bull Ability to lead andmanage a cross-functional team in the planning, development and resolution of complex projectsissues. bull Excellent written, verbal, and presentation skills. bull Demonstrated ability to develop and present a wide variety of complex materials and communications that will be used to effectively reach both internal and external customers, and build trusting relationships through collaborative work activities. bull Strong proposal writing and editing skills. bull Proactively and accurately assesses the time and resources needed to complete an assignment. bull Experienced in teaching others to research and resolve customer inquiries by identifying trends and utilizing available resources. bull Self-motivated with excellent time management and organizational skills. bull Ability to work and communicate with high level executives and government officials. bull Must possess current certification, including necessary licenses, for the field of specialty. (as required by the position)

Keywords: Cosmos IT Solutions, West Sacramento , Insurance/Healthcare Consultant, Healthcare , West Sacramento, California

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