The Special Needs Plan (SNP) Program Case Manager provides a holistic care model which involves collaboration with members and their families, caregivers, and providers.

The Provider Dispute Resolution and Appeals Specialist (“Specialist”) is responsible for processing provider appeals and disputes accurately and timely.

Supports the Provider Relations Field Representative to achieve department goals. Responds to customer service and provider relations inquiries from providers and assist with problem resolution of issues. Coordinate’s provider submissions to internal departments via required forms.

The Medicare Enrollment Supervisor serves as a proxy for the Manager of Enrollment and Reconciliation, overseeing the activities and personnel of the Enrollment department while ensuring its processes operate smoothly.

Under the direction of the Claims Manager, the Claims Examiner III reviews and adjudicates complex or specialty claims, submitted either via paper or electronically.

The Agency Account Executive is responsible for helping the regional teams to achieve Clever Care’s established Medicare enrollment objectives in their assigned language segments, by working with the Regional Managers and Field Agency Leaders to drive enrollments through contracted Agencies and Agents.