Most Recent Healthplex, Inc. Job Listings

A Provider Relations Representative performs all responsibilities relating to provider issues.

SUMMARY: An Outreach Representative in the Government Services department works directly with members and provider offices to increase utilization and access / availability of services to members.

SUMMARY: An Outreach Representative in the Government Services department works directly with members and provider offices to increase utilization and access / availability of services to members.

A Dental Claims Processor adjudicates dental claims based on summary plan descriptions.

A Data Entry Technician in the Claims Department is responsible for accurately entering data from claim forms.

A Web Application Developer designs critical components of internal and external web applications to achieve project goals and deliverables. Individual must be extremely well-rounded with respect to database, back-end and front end abilities. Duties also include testing, debugging and application support.

A Report Analyst determines report requirements, identifies target data, builds/maintains appropriate data model, establishes/maintains data transformations, creates/modifies required queries, creates/modifies report presentation, verifies report accuracy, delivers the finished report, documents report process and maintains the reporting schedule.

SUMMARY: A dental Customer Service Representative receives, investigates and responds to all member inquiries regarding dental plan coverage, status of claims and provider information on all Government related plans.

SUMMARY: Investigates and resolves member complaints, appeals, grievances and fair hearings for Healthplex and client groups. Provide administrative support to Director of Quality Management and Vice President.

ESSENTIAL DUTIES AND RESPONSIBILITIES: Include the following. Other functions may be assigned as business conditions change.  Research provider information for Oracle database updates  Track submitted provider updates in Oracle database  Compile and maintain current managed care provider panel mapping  Collect and distribute weekly managed care provider panel updates to department members ...