Excellus Health Plan Inc.

Job Description: Summary: This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources and assists with navigating resources available and provide assistance with addressing SDoH barriers and care gaps. This position educates and assists with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE): On and Off Marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market - Qualified Health Plan (QHP). This position requires working occasional evenings and weekends for outreach and community events. Essential Accountabilities: Level I • Educates Medicaid, Medicare, and Commercial members on healthcare benefits, and community...

Job Description: Summary The Fixed Asset and Lease Accountant will be a part of a team responsible for the accounting and financial reporting functions of the Lifetime Healthcare Companies' fixed asset and leases, including, but not limited to, the preparation of external (U.S. generally accepted accounting principles ("GAAP") and statutory accounting principles ("SAP") and internal reporting, financial statement disclosures, regulatory and external audit support and is an integral member of the monthly, quarterly, and annual accounting close process. This role is highly collaborative with various internal departments (Finance, facilities, operations, etc.). This role understands relevant fixed asset and lease-related GAAP (i.e. FASB Accounting Standards Codification 320 and 842) and SAP (i.e. Statement of Statutory Accounting Principles No. 22) and reporting to ensure the accuracy of financial data and supports ad-hoc fixed asset and lease-related requests. Essential...

Job Description: Summary: This position is responsible for the design and development of curriculum for instructor-led and online learning programs throughout the Enterprise. The Instructional Designer will partner with authors, managers and subject matter experts in curriculum development, course design and material. They will work closely with the curriculum developers and documentation coordinators to maintain learning support resources. Serve as a liaison between Learning & Development and all training functions in the organization to foster collaboration about learning & development. This position will work on a wide variety of projects and must be able to handle multiple projects effectively. Essential Accountabilities: All levels Responsible for the design, analysis, and development learning content for instructor-led training (ILT), virtual-instructor led training (VILT), eLearning and blended learning experiences. Responsible for creating and...

Job Description: Summary: This position serves as the expert and leader for clinical and care management activities and overall coordination of Case and Disease Management, specifically related to transplants and catastrophic conditions. This position oversees the clinical and administrative operations and implementation of Member Care Management activities, including systematic approaches to improve member health status, and expectation set forth by regulatory and accrediting entities. Essential Accountabilities: Leads team members by communicating and guiding toward achieving department objectives. Establishes a foundation for strong teamwork and customer service. Provides ongoing supervisory and staff development and ensures adequate staffing to accomplish corporate goals. Participates in the recruitment, training and retention of staff. Provides planning and coordination of all facets of clinical care for potential and actual transplant candidates Manages end-to-end...

Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers. Essential...

Job Description: Summary: The Investment Accountant will be a part of a team responsible for the accounting and financial reporting functions of the Lifetime Healthcare Companies' investments, including, but not limited to, the preparation of external (generally accepted accounting principles (GAAP) and statutory) and internal reporting, financial statement disclosures, regulatory and external audit support and is an integral member of the monthly, quarterly, and annual accounting close. This role is highly collaborative with internal Treasury, Tax, and Finance groups as well as external custodians, investment managers, consultants, and third-party service providers. This role understands relevant investment-related GAAP and statutory accounting rules and reporting to ensure the accuracy of financial data and supports ad-hoc investment-related requests. Essential Accountabilities: Level I Supports the monthly, quarterly, and annual close process for the Lifetime...

Job Description: Summary: The Principal Artificial Intelligence (AI) Security Engineer serves as the technical lead for securing machine learning (ML), generative artificial intelligence (GenAI), and agentic systems in production, with emphasis on healthcare and other regulated environments. This role creates security architecture, threat modeling, control design, and detection strategy across the AI lifecycle, including data ingestion, feature engineering, training and fine-tuning, evaluation, model serving, retrieval-augmented generation (RAG) pipelines, agent frameworks, application programming interface (API) mediation, and post-deployment monitoring. The Principal AI Security Engineer leads and partners throughout the organization to build enforceable guardrails for protected health information and electronic protected health information handling, identity and access control, secrets isolation, model and dataset provenance, output safety, and evidence collection for...

Job Description: The Medical Director participates in the broad array of activities of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, and support for our various lines of business. The incumbent also provides input into the development of policies, programs and strategic objectives that cover Medical Management Services through their required participation in various committees and when assigned to other committees or workgroups as requested by leadership. They also act as a liaison with local physicians and hospitals and keep abreast of practice patterns, issues, and concerns of their regional medical community, as well as support our Provider Relations team as requested. This position is occasionally required to work evenings during high volume periods and staff shortages, e.g. cross-coverage vacations. Essential Accountabilities: Level I...

Job Description: Job Description Based on the scope of the role & business needs, we're exclusively seeking candidates who reside in the Greater Syracuse & Utica region (Jefferson, Onondaga, Oneida, Madison and Broome Counties) Summary: The Medicare Broker Account Executive will be responsible for building and maintaining strong relationships with Medicare brokers to drive the sales and growth of our Medicare products This involves close collaboration with Field Marketing Organizations (FMO), General Agents, and Individual Agents to ensure compliance with all relevant policies and procedures. This role will require a strategic approach to broker engagement, sales support, and market development. The ideal candidate will have a deep understanding of Medicare products, comprehensive understanding of Medicare sales dynamics, excellent interpersonal skills, and the ability to foster positive broker relationships. Essential Accountabilities: Broker Relationship...

Job Description: Summary: This role will require coming into the Rochester office. The LTC Benefits Planner (Personal Care Advisor) has the responsibility of evaluating and managing those Insureds that are accessing their benefits based on their need for long-term care services. This includes ongoing evaluation of the Insured's eligibility for benefits, appropriateness of the plan of care, coordination of other insurance policies/providers, documentation and communication with Insured, Insured's family, care providers, and monitoring of claim submission and processing. All work is directed under the terms and conditions of the various individual insurance contracts. Essential Accountabilities: Level I Operates as a case advisor for Insureds accessing benefits under their LTC policy as key contact and advocate for Insured and their family. Independently manages a caseload of Insureds in accordance with time-service standards required by the Company. Evaluates...

Job Description: Thank you for your interest in our Customer Care team. Due to the volume of applications we receive, we review all applications in the order in which they were received. If you are chosen to move to the next step in the process, you will receive a Video Assessment from recruiting@jobalerts.excellusbcbs.com. Summary The Customer Care (CC) Advocate resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements. The Customer Care Advocate provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently. Essential Responsibilities/Accountabilities...

Job Description: Thank you for your interest in our Customer Care team. Due to the volume of applications we receive, we review all applications in the order in which they were received. If you are chosen to move to the next step in the process, you will receive a Video Assessment from recruiting@jobalerts.excellusbcbs.com. Summary The Customer Care (CC) Advocate resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements. The Customer Care Advocate provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently. Essential Responsibilities/Accountabilities...

Job Description: Thank you for your interest in our Customer Care team. Due to the volume of applications we receive, we review all applications in the order in which they were received. If you are chosen to move to the next step in the process, you will receive a Video Assessment from recruiting@jobalerts.excellusbcbs.com. Summary The Customer Care (CC) Advocate resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements. The Customer Care Advocate provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently. Essential Responsibilities/Accountabilities...

Job Description: This position is onsite/in-person at our Court St. office in Rochester, NY. Multiple Overnight Openings Available! Schedule 1: Mon - Thurs: 10PM - 6:30AM, & Fri: 11:55PM - 8:30AM Schedule 2: Sun-Thurs : 10PM - 6:30AM *New hires will temporarily orient on days to start. Summary: Under general supervision of department management, the Production Floor Operations Specialist may support one or more areas of Production Operations. Assignments are determined based on need; shifts may include day, evening and/or overnight hours, with some including weekend coverage. NOTE: Incumbent will be notified 3 days ahead of any shift assignment adjustment. Essential Accountabilities: All Levels • Specific work activities are assigned daily based on work volumes and department need. • Observes safety and housekeeping standards in work area. Maintains appropriate files, records and equipment manuals. • Informs supervisor of equipment issues. •...

Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation, and/or inpatient coding and has a high level of understanding of the current MS-DRG, and APR-DRG payment systems. This position is responsible for reviewing medical records for appropriate provider documentation to support the principal diagnosis, co-morbidities, complications, secondary diagnosis, surgical procedures, POA indicators to validate coding and DRG assignment accuracy, insuring the physician documentation supports the hospital coded data. Essential Accountabilities: Level I • Analyzes and audits acute inpatient claims. Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise. Clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently....

Job Description: Summary: The Software Engineer is responsible for working on projects that are currently being visualized or developed by our organization. This role will be involved with the Software Development Life Cycle methodology and framework, directing software system validation and testing methods, as well as directing software programming initiatives. This position works closely with clients and cross-functional departments to communicate project statuses and proposals. This role is specific to ETL Development: Key information - Knowledge of Programming languages: XML, JavaScript, SQL Developer Tools: Git, Azure Devops, CDIPC - Cloud Data Integration for PowerCenter ETL Process Development: Design, develop, and maintain ETL processes using Informatica PowerCenter or other relevant Informatica tools. SQL Proficiency: Utilize SQL/PLSQL to extract, transform, and load data. Exposure to advanced transformations like data transformations, Parsing JSON/XML messages...

Job Description: Summary: The IT Cloud Engineer - Security provides the vision, strategy, functionality, and technology solutions for creating and maintaining security system and solutions for both public and private cloud infrastructure-based solutions. This position collaborates with the Information Technology teams to lead the organization toward the deployment of technologies which focus on the trust, risk, and security management of the company environment. These may include PaaS, SaaS, hosted, and on-premises solutions - allowing for flexible, secure, on-demand cloud-like functionality and services while endeavoring to provide resiliency and achieve cost reduction, while maintaining a highly secure and flexible environment. Essential Accountabilities: Level I Enforces and integrates security solutions, tools, and appropriate controls to align to security policies, standards, and procedures. Stays current with leading security technologies, standards, and best...

Job Description: Summary: The Pharmacy Analytics Consultant provides direct support for both Pharmacy and Medical Drug information needs using a variety of analytic tools and applications. The Consultant will work with internal and external stakeholders and management, as required, to achieve Pharmacy Markets strategy, growth, compliance, and affordability objectives across the enterprise. The analyst collaborates with a multidisciplinary team (e.g., clinical, financial, sales, and Line of Business Leaders) to recommend actionable items leading to positive pharmacy financial performance. This position prepares and presents information to enable both senior management and our customers to better understand, evaluate, and support their goals. Essential Accountabilities: Level I Perform research on projects and manage and lead projects to successfully meet business objectives from across the enterprise. Analyzes data to determine business problem, trends or opportunities...

Job Description: Summary: Under the guidance of the SIU Management, this position is responsible for the accurate and thorough clinical investigation of potential fraud, waste and abuse (FWA) for all lines of business. The scope of accountability includes investigating and remediating allegations of FWA while adhering to compliance and regulatory requirements. Primary activities include substantiating referrals, case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and appropriateness of care, interviewing potential witnesses, developing corrective action plans, developing correspondence to impacted parties, managing disputes, and collaborating with law enforcement and regulatory agencies. Essential Accountabilities: Level I Functions as a clinical reviewer of medical records, researching and investigating complex medical cases. Interprets a variety of documents including, but not limited to...

Job Description: NOTE: Based on business needs and geographic territory associated with this opening, we are exclusively seeking candidates who reside in Rochester, NY. Summary: The Account Sales Consultant is responsible for prospecting new sales while providing service solutions for existing accounts. In accordance with established annual sales and retention goals, the Account Sales Consultant will provide existing accounts and brokers with education, benefit consulting, guidance, and coordination of benefit plans. Accounts are a mix of experience rated accounts including fully insured and self-funded. This group manages medical and all ancillary lines of business for accounts with over 100 full-time equivalents. Essential Accountabilities: Level I Establishes, develops, and maintains positive business relationships with prospective and current clients, brokers, and internal department contacts. Researches accounts and generates or follows through on sales leads....