The primary purpose is to provide carrier support by assisting the payments department and management in identifying and resolving carrier issues or concerns related to payments. This role acts as a liaison between external carriers and the internal payment team to research, review, and resolve these payment-related requests.

The Reinsurance Nurse Case Manager assists the Claim and Underwriting Departments by evaluating clinical and claim data to identify potential risk and mitigate claims exposure. This role involves working with Third-Party Administrators and Case Managers on high-dollar catastrophic claims and providing clinical review for reserve recommendations.

The specialist will act as a liaison between patients, physicians, and insurance providers to secure necessary pre-certifications and authorizations for scheduled hospital and clinical procedures. This involves navigating complex insurance regulations and efficiently processing all required documentation.

The primary purpose is to manage the technical and operational functions of assigned office(s), ensuring compliance with company standards and industry best practices while delivering quality services. This role is also responsible for staffing, training needs, budget preparation, and profit and loss management for the location, directly supervising 25-49 colleagues.