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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Position Overview: Coordinate and respond to all requests for clinical claim (all lines-of-business) reviews across PacificSource Health Plans. Ensure proper utilization of services and resources, medical bill cost assessment, and cost containment. Provide direct assistance to the underwriting and actuarial departments for new and renewing group underwriting requests. Interface with Reinsurance Group of America (RGA). Coordinates with the Health Services staff as needed and indicated for clinical documentation and/or additional information/support. Researches clinical trends and trains PacificSource staff, as necessary.
Essential Responsibilities:
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