Elevance Health

Events

• Travels to worksite and other locations as necessary 25-30%.
• Meets with customers to identify parameters of events.
• Recommends appropriate format.
• Coordinates promotion of event to target audience.
• Identifies and recruits presenters, speakers, and event volunteers.
• Assists in the preparation of presentations when requested.
• Negotiates with vendors to make event arrangements.
• Serves as the onsite host/hostess for client.
• Communicates event status.
• Conducts follow-up to assess effectiveness of events.
• Develops and tracks meeting budgets.
• Seeks feedback after events and applies lessons learned to improve future planning and execution.
• Builds effective working relationships with internal partners, vendors, presenters, volunteers, and attendees.
• Uses sound judgment to identify issues, escalate risks, and recommend practical solutions during event planning and execution.

Event Planner

Customer Support

• responsible for responding to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims
• Analyzes problems and provides information/solutions
• Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database
• Thoroughly documents inquiry outcomes for accurate tracking and analysis
• Develops and maintains positive customer relations and coordinates with various functions within the company
• Researches and analyzes data to address operational challenges and customer service issues
• Provides external and internal customers with requested information
• Receives and places follow-up telephone calls / e-mails to answer customer questions
• Outbound calls are conducted in the ZipDrug business area
• Seeks, understands and responds to the needs and expectations of internal and external customers
• Expected to have the ability to multi-task

Community Pharmacy Outbound Customer Care Representative II

General Counsel

• Works with more experienced attorneys to represent the organization in legal duties
• May research legal principles and precedents, consult with outside counsel, draft and execute legal documents
• Gathers relevant case related information using multiple sources and methods
• Contributes to overall results of an SBU or CEE unit and/or department
• Serves as a strategic partner with assigned internal clients
• Provides legal solutions to a wide range of difficult or new problems
• Develop recommendations and solutions that are thorough, practical and consistent with organizational objectives
• May support the development of other attorneys and paralegals by providing guidance on technical and tactical procedures for lower level attorneys
• Begins to assume management of outside counsel on routine matters

Senior Legal Counsel

Pharmacist

• Managing the selection and utilization of pharmaceuticals
• Supporting core clinical programs such as DUR, DIS and formulary management
• Researching and synthesizing detailed clinical data related to pharmaceuticals
• Preparing and presenting therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee
• Reviewing and approving or denying coverage for pharmaceuticals based on medical necessity criteria
• Serving as a clinical resource to other pharmacists
• Providing dosage conversion and clinical support for therapeutic interventions
• Preparing information for network physicians

Clinical Pharmacist

Medical Billing and Coding

• managing a team that audits, reviews, and codes medical records for the purpose of reimbursement and compliance using ICD-9 and CPT codes
• Develops, implements, and monitors policies, procedures, and systems for proper coding and quality assurance
• Manages workloads, training, and problem resolution
• Oversees all facets of the daily operations and ensures compliance
• Develops and implements systems and processes to establish and maintain records for the operating unit
• Manages projects designed to improve billing practices and increase revenues
• Assists physicians and providers with questions and problems related to coding and billing
• Plans, organizes, and conducts individual and group provider in-service programs
• Conducts quality control studies and audits and implements solutions
• Trains staff on coding, documentation and billing regulations
• Participates in developing, implementing, and maintaining policies and objectives
• Hires, trains, coaches, counsels, and evaluates performance of direct reports

Manager, Medical Coding Analysis

Manager

• Overseeing and monitoring the day-to-day workflow of clinical support staff
• Serving as a subject matter expert in the administrative and operational processes
• Assisting in problem solving complex issues and cases, such as provider calls, e-services, and authorization issues
• Overseeing out of network and chart review administrative processes
• Collaborating with internal departments on special projects and reporting
• Hiring, training, coaching, counseling, and evaluating performance of direct reports

Associate Manager, Clinical Support

Security Engineer

• Responsible for designing, implementing, and supporting enterprise network decryption solutions across hybrid on-premise and cloud environments
• Ensures secure visibility into encrypted traffic
• Helps maintain compliance with enterprise security standards, policies, and regulatory requirements
• Partners with infrastructure and security teams to deliver secure, scalable, and well-architected network security solutions
• Supports system and network architecture support for information security and network decryption technologies
• Supports development and execution of risk assessment methodologies
• Supports development of requirements, system architecture, and technical design of network security and decryption solutions
• Supports development of strategies for discovery, evaluation and response to emerging network and encrypted traffic threats
• Develops security incident response plans and operational support strategies
• Provides trouble resolution and serves as point of technical escalation on complex network, certificate, and decryption-related issues
• Creates presentations and seeks IT management approval
• Designs & engineers comprehensive network decryption solutions based on business requirements and defined technology standards

Information Security Advisor – Network Decryption Engineer

Medical Director

• Oversees the administration of behavioral health services to ensure members receive appropriate, high-quality, and cost-effective care
• Provides clinical consultation and strategic guidance to strengthen clinical operations
• Supports the design and implementation of initiatives that improve quality, outcomes, and affordability
• Identifies and develops opportunities for innovation to increase effectiveness and quality
• Conducts peer-to-peer clinical reviews with attending physicians or other providers
• Serves as a resource and consultant to other areas of the company
• Attends Behavioral Health interdisciplinary team (IDT) meetings and other team-related meetings regularly

Behavioral Health Medical Director – Psychiatrist

• Provide support to pharmacy staff through administrative and clerical tasks
• Assist pharmacists in daily operations
• Contact members to remind them to refill medications on time
• Work with pharmacies and providers for timely refills of chronic medications
• Arrange medication deliveries to members

Pharmacy Coordinator

• Provides strategic planning and account management for large accounts
• Directs and manages the administration of contractual requirements and obligations
• Manages the new and renewal implementation process for accounts
• Interfaces with operations to ensure smooth delivery of services
• Maintains ongoing account relationships at multiple levels throughout the customers' organizations
• Makes recommendations for improvements to meet customers' expectations
• Provides both on-site and off-site customer service
• Coordinates open enrollment meetings, renewal process and training sessions
• Makes routine account visits

Account Service Manager

• Evaluate vendor security documentation, including SOC reports, ISO certifications, HITRUST certifications, penetration test summaries, security questionnaires, policies, data flow diagrams, and remediation evidence.
• Assess vendor controls related to access management, encryption, vulnerability management, incident response, business continuity, disaster recovery, cloud/SaaS security, secure software development, and data protection.
• Provides first level engineering design functions and trouble resolution.
• Communicate directly with vendors to clarify questionnaire responses, request supporting evidence, validate remediation status, and coordinate risk mitigation activities.
• Support internal and external audit and compliance activities, including HIPAA, HITRUST, NIST, PCI DSS, SOC 2, and other healthcare or cybersecurity-related assessments.
• Provides trouble resolution and serves as point of technical escalation on complex problems.
• Leads or plans implementations for access management and network security technologies.
• Develops testing plans to ensure quality of implementation.
• Leads the investigation and reporting of data security events and incidents.
• Provides system and network architecture support for information and network security technologies.
• Provides technical support to business and technology associates in risk assessments and implementation of appropriate information security procedures, standards and technologies.
• Maintains security incident response plans.
• Represents major upgrades and business system replacements in change control.
• Oversees Enterprise mix of vendor services.
• Recommends changes and updates to strategy.
• May act a key contact for setting vendor strategy.
• Designs & engineers repetitive technical solutions based on business requirements and defined technology standards.
• Mentor junior analysts by providing guidance on assessment quality, evidence review, control interpretation, risk documentation, and stakeholder communication.
• Contribute to continuous improvement of third-party cybersecurity risk management standards, procedures, workflows, assessment templates, risk scoring methodology, dashboards, and reporting.

Third Party Cybersecurity GRC Advisor

• Responsible for leading and supporting Payment Card Industry Data Security Standard (PCI DSS) compliance activities across the enterprise
• Provides subject matter expertise for PCI DSS control interpretation, assessment readiness, evidence review, remediation tracking, scope validation, control testing, and stakeholder engagement
• Supports PCI Internal Security Assessor (ISA), Qualified Security Assessor (QSA), Report on Compliance (ROC), Self-Assessment Questionnaire (SAQ), Attestation of Compliance (AOC), and related PCI DSS assessment activities across business, technology, security, compliance, and third-party environments
• Evaluates third-party service provider PCI responsibilities, including review of AOCs, responsibility matrices, shared responsibility documentation, contracts, service descriptions, and supporting security evidence
• Supports internal and external audit activities related to PCI DSS, HIPAA, HITRUST, SOC 2, NIST, and other cybersecurity or regulatory compliance requirements
• Mentors analysts and control owners by providing guidance on PCI evidence quality, control interpretation, assessment documentation, remediation planning, and stakeholder communication
• Contributes to continuous improvement of PCI compliance processes, templates, workflows, reporting, evidence management, automation opportunities, and program maturity initiatives

Cybersecurity PCI Compliance Advisor

• collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers
• Performs care management activities within the scope of licensure for members with complex and chronic care needs
• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care
• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance
• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge
• Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary

Nurse Care Manager

• Support internal and external audit and compliance activities, including HIPAA, HITRUST, NIST, PCI DSS, SOC 2, and other healthcare or cybersecurity-related assessments.
• Lead cybersecurity risk assessments and due diligence reviews for third-party vendors, service providers, SaaS platforms, cloud providers, and other external business partners, including high-risk and critical vendors.
• Evaluate vendor security documentation, including SOC reports, ISO certifications, HITRUST certifications, penetration test summaries, security questionnaires, policies, data flow diagrams, and remediation evidence.
• Communicate directly with vendors to clarify questionnaire responses, request supporting evidence, validate remediation status, and coordinate risk mitigation activities.
• Provides trouble resolution on complex problems and leads implementations for system and network security technologies.
• Develops testing plans to ensure quality of implementation; coordinates and prepares the reporting of data security events and incidents; provides system and network architecture support for information and network security technologies.
• Provides technical support to business and technology associates in risk assessments and implementation of appropriate information security procedures, standards and technologies.
• Represents major upgrades and reconfigurations in change control.
• Design & analyze mix of vendor services meeting business and information security requirements.
• Determine and perform complex configuration changes to meet business and information security requirements.
• Serve as the technical escalation for results of preventative maintenance routines.
• Participate in metrics development, trend analysis, quality reviews, and program maturity initiatives to strengthen Elevance Health’s third-party cybersecurity risk management program.
• Represents infrastructure security support in significant projects and performs the most complex operations and administration tasks.
• Respond to level 3 & 4 change and problem requests without supervision.
• Lead level 1 & 2 incident recoveries and root cause analysis.

Senior Third Party Cybersecurity GRC Analyst

ServiceNow

• Responsible for leading the design, development, configuration, enhancement, and ongoing optimization of ServiceNow capabilities
• Serve as a subject matter expert for ServiceNow application functionality
• Design scalable workflows to support PCI DSS assessment activities
• Leads system and network architecture support for information and network security technologies
• Develops security incident response plans and strategies
• Provides trouble resolution and serves as point of technical escalation on complex problems
• Creates presentations and seeks IT management approval
• Designs & engineers comprehensive access management and network security technical solutions based on business requirements