Health Insurance Case Manager - 6 Month Contract (may Convert) (62486)

HEALTH INSURANCE CASE MANAGER

CONTRACT: 6 months (W2); possible conversion to FTE

START DATE: ASAP

LOCATION: San Diego, CA

JOB NUMBER: 62486

CLIENT: One of the country's largest health care and health plan providers

WORKSITE LOCATION: CSC

HOURS: M-F 8am - 5pm; possible OT as needed

NUMBER OF TEAM MEMBERS: Currently 5

SCOPE OF PROJECT: For the On-Exchange - Enrollment monitoring and resolving cases

JOB SUMMARY:

- We are searching for candidates with technical background, insurance health plan experience (such Kaiser, Blue Cross, Optum, or Blue Shield, other health plans), case management, business analysis, quality assurance, regulatory, project management.
- A combination of any of these preferred qualifications is important for this role. A candidate with the ability to multitask and work efficiently while mitigating risk in a fast pace productivity environment. Also have the ability to communicate with members, leaders and providers.

TOP DAILY RESPONSIBILITIES:

- Review enrollment cases and determine the severity level
- Research level 1 cases
- Follow up and update member cases documentation (new and old)
- Research level 2 cases
- Follow up and update member cases documentation (new and old)

REQUIRED EDUCATION, EXPERIENCE, AND SKILLS:

- Bachelor's Degree
- 2-3 years' experience
- If the candidate does not have a bachelor's degree they must have at least 4 years' experience in auditing, case management, quality assurance, process improvement or a related field
- Health insurance experience
- Auditing experience
- Analytical skills
- Preference for people who have worked in case management or SharePoint or QA