HealthAxis Group

Medical Director

• Responsible for working hand-in-hand with senior leaders to provide medical expertise and decision making within the Utilization Management team.
• Responsible for ensuring that healthcare services are medically necessary, appropriately utilized, and meet the highest standard of quality.
• Adhere to standard Federal, State and/or CMS compliant medical policies within the organization.
• Reviewing clinical cases, providing medical expertise, and collaborating with various stakeholders to ensure efficient and effective healthcare delivery.
• Maintaining accurate and thorough documentation of activities and decisions.
• Analyzes aggregate data and reports to primary care physician.
• Serves as the liaison between physicians and health plan Medical Directors.
• Participates in the Grievance and Appeal review process to provide recommendations.
• Identify process improvements opportunities and inefficiencies.

Part-Time Medical Director – Utilization Management

Customer Support

• Answers all telephone calls within established department standards.
• Tracks all calls within the Health Axis and IKA databases ensuring that documentation is concise and factual.
• Participates in new employee orientation program and ongoing education programs as directed by Supervisors.
• Responsible for fully understanding the OTC benefits, medical management processes, demographic change processes, and process for changing Primary Care Physicians (PCP).
• Answers benefit questions, detailed claims inquiries and general questions from members and providers.
• Maintains a positive and professional attitude.
• Attention to detail is required to maintain quality metrics within the call center.
• Maintains appropriate current source documents and reference documents.
• Performs quality work within deadlines with or without direct supervision.
• Interacts professionally with other employees, customers and suppliers.
• Works effectively as a team contributor on all assignments.
• Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.

Customer Service Representative

Insurance

• Responsible for processing claims in accordance with production, timeliness and quality standards.
• Participates with other health plan departments in the resolution of claims issues across department lines.
• Ensures claims are processed in compliance with governmental and accrediting agency regulations.
• Ensures the delivery of superior customer service by providing timely and accurate claims payment and responding timely to member and provider inquiries and complaints regarding claims processing.
• Develops strong intradepartmental relationships with other department personnel and/or exempt individual contributors to ensure clear communication and prompt resolution to issues.
• Follows departmental policies and procedures regarding claims adjudication.
• Ensures that potential fraudulent claims practices are identified and reported to the appropriate compliance department.
• Follows all HIPAA compliance guidelines to ensure protection of member protected health information.
• Responsible for driving the HealthAxis culture through values and customer service standards.
• Accountable for outstanding customer service to all external and internal contacts.
• Develops and maintains positive relationships through effective and timely communication.
• Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.

Claims Specialist

• Provides medical expertise and decision-making within the Utilization Management team
• Ensures healthcare services are medically necessary and appropriately utilized
• Reviews clinical cases and collaborates with various stakeholders
• Participates in case reviews and medical necessity determination
• Conducts post-service reviews issued for medical necessity and benefits determination coding
• Analyzes aggregate data and reports to primary care physicians
• Serves as the liaison between physicians and health plan Medical Directors
• Identifies process improvements opportunities and inefficiencies

Medical Director, Utilization Management

Analyst

• Ensure that health plan systems and software are accurately configured to support business operations, regulatory compliance, and the efficient delivery of services to members.
• Configure and maintain health plan software systems.
• Define and implement business rules and logic for claims processing, member eligibility, benefits administration, and provider contracts.
• Perform system testing to ensure accurate configuration of health plan systems and software.
• Manage and configure data feeds from external vendors or internal systems.
• Stay up-to-date with federal, state, and local health plan regulations.
• Generate configuration-related reports to assess system performance and support decision-making.
• Investigate and resolve issues related to system configurations.
• Maintain thorough documentation of all system configurations, processes, and changes made to the systems.

Configuration Analyst

Support Engineer

• Lead engaging product demonstrations and solution presentations for prospective and new customers.
• Collaborate with clients to gather and analyze business and functional requirements.
• Design and document requirements to configure the SaaS application to support customer-specific workflows for claims, authorizations, eligibility, and member management.
• Support customer onboarding, testing, and go-live activities.
• Work with interoperability teams to establish data integrations via APIs, HL7/FHIR, or X12 transactions.
• Troubleshoot configuration, data, and performance issues, providing resolution and documentation.
• Develop and maintain solution documentation, configuration guides, and client-specific reference materials.
• Partner closely with Product Management, Engineering, and Customer Success teams to ensure a seamless implementation experience.
• Contribute to continuous improvement of solution templates, configuration standards, and onboarding processes.
• Act as a trusted advisor to clients, helping them align system capabilities with operational best practices.
• Perform deep technical tasks related to HealthAxis applications, diagnostic/fix skills.
• Diagnose and troubleshoot technical issues, including account setup, configuration, & on-going support.
• Build knowledgebase by managing the creation of documentation that describes technical solutions.
• SLA Management and Enforcement with consistent delivery of excellent customer service.
• Validate interface transmissions and the execution of various batch processes.
• Research and identify solutions to software issues, utilizing internal and external resources.
• Provide prompt and accurate feedback to customers.
• Maintain a current level of knowledge and expertise on supported HealthAxis systems.

Senior Application Support Analyst

Operations

• Oversee day-to-day execution of all operational functions to manage, meet or exceed client expectations across all service lines.
• Provide hands-on planning and guidance to functional teams to meet deliverable requirements, SLAs and maintain customer satisfaction.
• Own Implementation Team delivery with focus on budget ownership, project planning, resource allocation, and delivery outcomes.
• Maintain, manage and meet departmental budgets for implementation and operational teams; align revenue targets with forecasted COGS.
• Optimize team structures and roles through offshoring, automation, and continuous process improvement.
• Create and empower agile, accountable teams fostering a culture of innovation, ownership, and problem-solving.
• Establish and maintain internal KPIs and SLAs that exceed client commitments leveraging real-time data.
• Continuously evaluate and implement efficient workflows, integrating technology and automation to enhance claims processing, call center performance, and enrollment functions.
• Lead outsourcing and offshoring strategy to create capacity, control costs, and scale operations.
• Drive deployment of agentic automation across operations, delivery, and implementation to eliminate inefficiencies and accelerate time-to-value.
• Ensure strict adherence to regulatory compliance and performance standards while delivering high-quality outcomes.
• Provide timely, transparent updates and reporting to stakeholders to support decision-making.
• Provide strategic insight and recommendations to the CEO and executive team on operational optimization, technology adoption, and fiscal accountability.
• Develop, monitor, and manage department budgets and forecasts; manage vendor relationships and performance related to operations and implementation.
• Collaborate cross-functionally to develop and implement operational, strategic, and technical enhancements that elevate service quality and customer experience.
• Lead, manage and hold teams accountable for results; perform other executive-level initiatives as assigned.

Senior Vice President, BPO Operations and Implementation

• Receive, investigate and respond to member and provider calls regarding claims, benefits or general inquiries
• Answer all telephone calls within established department standards
• Track all calls within Health Axis and IKA databases ensuring documentation is concise and factual
• Participate in new employee orientation program and ongoing education programs as directed by Supervisors
• Understand OTC benefits, medical management processes, demographic change processes, and process for changing Primary Care Physicians (PCP)
• Answer benefit questions, detailed claims inquiries and general questions from members and providers
• Maintain a positive and professional attitude and appropriate current source and reference documents
• Perform quality work within deadlines with or without direct supervision and maintain quality metrics
• Interact professionally with employees, customers and suppliers and re-direct calls as required
• Participate in projects as assigned by supervisors