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Tufts Health Plan Business Jobs

168 Jobs Found

MINIMUM QUALIFICATIONS: Bachelor's degree preferred or equivalent work experience. Minimum of 10 years field sales experience or provider relations experience, with a proven track record of establishing, building, and managing accounts preferr......
Bachelors degree in business, mathematics, economics, statistics, or finance or equivalent work experience of 2-3 years in an analytical and technical role. Ability to write SQL queries, preferably in a managed care insurance environment. Inte......
The Audit Senior position reports to the Audit Senior Manager and provides management for the audit activities assigned. The position supports the Audit Senior Manager in his/her leadership of the functional area of business they audit and is respon......
Under the supervision of the manager, the Enrollment Systems Analyst will provide analysis and technical support to the Member Enrollment team. Analyst will research member data in multiple systems to identify the root cause of the data issues. Anal......
Provide daily operational administration for the HPUX server environment. Analyze and resolve problems associated with server hardware, operating systems. Monitor performance and resources and take steps to ensure optimal performance. Responsibiliti......
EDUCATION: (Minimum education & certifications required) Bachelor's degree, advanced degree preferred 0-4 years audit or financial services industry experience CIA, CPA preferred EXPERIENCE: (Years of experience) Healthcare Industry E......
Under the general direction of the Manager, Employer Experience the Quality Assurance Analyst is responsible for developing, monitoring, supporting, delivering and overseeing Quality Assurance processes from inception to finalization. These processe......
Under direction, manage all aspects of assigned project(s). In this role, the individual will work with department liaisons and may also work with project team members as required for the purpose of executing project requirements and meeting the tim......
Tufts Health Public Plans (THPP) is the division of Tufts Health Plan (THP) that focuses on serving managed Medicaid, and individual consumers in the state-based exchange market. POSITION SUMMARYThe Provider Relations Manager acts as the primary l......
EDUCATION: (Minimum educations & certifications required) A Bachelor's Degree is required, preferably in health care management, business, or related field (equivalent experience may be considered). EXPERIENCE: (Years of experience) The pos......
Qualifications (Minimum education & experience level required): Bachelors Degree required. Advanced degree or equivalent experience and education preferred. Business, law, or public administration degree strongly preferred. Minimum of five yea......
EDUCATION: Requires a J.D. and license to practice law in Massachusetts. EXPERIENCE: Minimum of 5 years relevant legal experience in a law firm or in-house environment; 3 years health or insurance law experience preferred SKILL REQUIREMENTS: ......
Primary responsibility is to provide legal services with respect to company matters involving or related to any of the following: provider contracting; Allied Health and PBM contracting; vendor contracting; clinical issues; credentialing, appeals an......
The Manager of Medicare Claims Operations Compliance is responsible for the development and implementation of the Medicare regulatory compliance plan and daily management of regulatory analysis and implementation. This includes: regular assessment o......
This position is responsible for analyzing the information security environment for THP and developing security measures to safeguard the confidentiality, integrity, and availability of data. Under direction, implement, monitor, assess and report on......
The Director of Field Sales will create strategy and drive to execution all provider and community based growth initiatives, assure optimized productivity from Field Sales efforts across senior health plan products, and assist in developing partners......
Education: High School Diploma or equivalent required. Associates degree preferred. Skills/Experience: 2 - 4 years experience in a service oriented position, preferably in a managed health care environment. Bilingual in Mandarin/Cantones......
Education: R.N., BS or BSN preferred, CCM preferred Skills/Experience: Minimum 3 years of acute care nursing, understanding of the different levels of care, computer skills, flexibility, and good verbal and written communication skills. Wil......
The Inpatient Medical Management Nurse will ensure that the Tufts Health Plan Public Plans member population receive timely concurrent review / interventions as established by the Medical Management Department of Tufts Health Plan Public Plans. Assu......
The primary function is to provide members and providers that contact the Call Center with answers to questions about Network Health and the services provided to our customers. Responsibilities * Serve as the primary contact for providers and memb......