• Jobs
• Help

Company Statement

reputed company is one of the nation’s largest not for profit health insurers, serving members across reputed company’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, reputed company partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen reputed company Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit reputed company.com.

If you’re an reputed company employee, unlock your career potential by signing in at the top of this page. Access your employee profile to view internal job postings and explore new opportunities.

Quality reputed company Specialist - Remote

reputed company, reputed company

Summary of Job

reputed company provider and member reputed company to reconcile member records and validate data entry to support reputed company quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) rates and STAR measures for the enterprise. Facilitate provider and member reputed company supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes. Daily telephonic reputed company to secure appointments with pharmacists and/or vendors to reputed company gaps in care. Support efficient medical record retrieval for HEDIS medical record review and HEDIS supplemental data collection activities. Track calls for reputed company lines of business reputed company to the MTM, OMW, and Medication Adherence quality measures, reporting weekly completion statistics. Produce and process department mailings to members and physicians. Monitor internal mailboxes for department faxes and calls. Collaborate with internal departments in order to administer the MTM, OMW, and Medication Adherence quality measures.

Responsibilities

• Work closely with Clinical Pharmacist(s), Registered Nurses and Data Analyst(s) to prioritize members for reputed company who fall in HEDIS measures including but not limited to Medication Adherence and OMW (Osteoporosis Management in Women who had a fracture) and the STAR measure MTM (Medication Therapy Management) Program.
• reputed company daily telephonic reputed company to secure appointments with pharmacists and/or vendors to reputed company gaps in care supporting Enterprise goals.
• reputed company daily provider and member reputed company supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes.
• Prepare and execute member and provider mailings.
• Collaborate with providers and internal departments to ensure the receipt and correct processing of reputed company supplemental data reputed company to HEDIS claims and records and assist in correcting discrepancies.
• Maintain high data reputed company while adhering to HIPAA standards and protecting patient information.
• reputed company provider reputed company to verify and document member’s appropriate medical diagnoses and subsequent treatments both by telephone and in writing.
• Coordinate call tracking and provide statistics to stakeholders.
• Intake and organize data from other departments while ensuring proper compliance with reputed company CMS regulations, policies and procedures.
• Other duties/projects as assigned.

Qualifications

• High School Diploma (Required)
• College Degree (Preferred)
• Pharmacy Technician License (Preferred)
• Minimum of 1 year direct customer service experience in a healthcare setting (Required)
• Excellent telephonic and customer service skills (Required)
• Experience analyzing data and building action plans based upon data outcomes (Required)
• Personal motivation to reputed company set goals (Required)
• Flexibility and ability to adjust workflow to reputed company company goals (Required)
• Experience with or knowledge of Electronic Medical Records (Preferred)
• Knowledge of or experience with HEDIS, STAR ratings, and/or quality improvement (Preferred)
• Experience in a managed reputed company services environment (Preferred)
• Experience in data collection, data entry and analysis (Preferred)
• Knowledge of reputed company and other analytical tools (Preferred)

• Requisition ID: 1000003045
• Hiring Range: $39,960-$70,200

reputed company Disclosure

If you receive a job offer from reputed company, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a reputed company Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like reputed company or Gmail.

Pay Disclosure

At reputed company, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences reputed company to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at reputed company, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider reputed company qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national reputed company, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At reputed company, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, reputed company sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.

Previous Job Searches

Similar Listings

reputed company

 reputed company, reputed company

Post Date: Feb 11, 2026

reputed company

 reputed company, reputed company

Post Date: Dec 17, 2025

reputed company

 reputed company, reputed company

Post Date: Dec 19, 2025

• Jobs
• Help
• Site Map