• Director , Initial Claims

    Humana (Madison, WI)
    …a part of our caring community and help us put health first** The Director , Initial Claims supports providers, members, and collection services in the processing ... adjudicating claims , along with researching and resolving claims inquiries. The Director , Initial Claims...to drive automation and establish robust audit practices on complex projects + Takes complex problems and… more
    Humana (08/09/25)
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  • Medicare/Medicaid Claims Reimbursement…

    Commonwealth Care Alliance (Boston, MA)
    …billing-related certifications **Required Experience (must have):** + 3+ years in healthcare claims processing, provider reimbursement, or payment integrity. + ... states will not be considered at this time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr.… more
    Commonwealth Care Alliance (05/31/25)
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  • Corporate Director , PFS Outsourcing…

    Prime Healthcare (Farmers Branch, TX)
    …trends and identify opportunities for process improvement and reimbursement optimization. + Complex Claims Management: identifies, trends, and owns portfolios of ... Outsourcing program across Revenue Cycle Management for all Prime Healthcare . The Corporate Director is responsible for... complex claims , including Third party claims , TDRG, Zero… more
    Prime Healthcare (06/20/25)
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  • Sr. Analyst , Pharmacy Claims Adjudication

    CVS Health (Wellesley, MA)
    …and key performance metrics for reconciliation, revenue cycle, and adjudication/ claims processes analysis. Facilitate effective solutions related to adjudication and ... processing of pharmacy and vaccine/medical claims , maintaining current services, support optimalization of existing vendor product portfolio, provide continual… more
    CVS Health (07/16/25)
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  • Sr. Director , RWD Analytics and Innovation…

    Norstella (Denver, CO)
    Sr. Director , RWD Analytics and Innovation ( Healthcare & Life Sciences) Company: Norstella Location: Remote, United States Date Posted: Jul 30, 2025 Employment ... India. **Job Description :** We are seeking a dynamic and visionary Senior Director of RWD (Real-World Data) Analytics and Innovation to lead real-world data special… more
    Norstella (07/09/25)
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  • Finance Director , Paragon…

    Elevance Health (Norfolk, VA)
    …senior management and prior leadership experience preferred. + Finance experience in a complex healthcare business, with complex data, such as Specialty ... **Be Part of an Extraordinary Team** **Finance Director - Paragon Healthcare ** _A proud...and reporting experience with large data sets such as claims data, drug therapy data, profitability analysis, gross margin… more
    Elevance Health (07/30/25)
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  • Occupational Health Medical Director

    Munson Healthcare (Traverse City, MI)
    HEALTHCARE 'S OCCUPATIONAL HEALTH TEAM! Full-Time | Monday-Friday | No Call Munson Healthcare is seeking a Medical Director for Occupational Medicine to lead ... injury/illness care, follow-up, and referral. Provide case management support for complex /long-term claims . + Provide leadership, direction and coordination of… more
    Munson Healthcare (07/14/25)
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  • Senior Director of Insurance & Risk…

    Hartford HealthCare (Hartford, CT)
    …And this is*your moment*. **Job:** **Management / Administration* **Organization:** **Hartford HealthCare Corp.* **Title:** *Senior Director of Insurance & Risk ... Work where*every moment*matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in...and Tallwood Urology & Kidney. Position Summary: The Senior Director of Insurance & Risk Financing will establish a… more
    Hartford HealthCare (07/10/25)
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  • Provider Contracting Director - Cleveland,…

    The Cigna Group (Independence, OH)
    …LOCATION: Must reside in the Cleveland or Independence, OH area.** The ** Director ** **,** **Provider Contracting Network Management** serves as an integral member of ... for a local given territory. **DUTIES AND RESPONSIBILITIES** + Manages complex contracting and negotiations for fee for service and value-based reimbursements… more
    The Cigna Group (06/25/25)
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  • Director , Consult Partner - Contact Center…

    Kyndryl (Atlanta, GA)
    …a key leadership role across multi-disciplinary teams, guiding them through complex consulting engagements and be responsible for creating and positioning strategic ... Kyndryl's largest accounts across the C-suite, spanning the intersection between complex Business and IT customer solutions, transformations that impact across the… more
    Kyndryl (07/29/25)
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  • Sr. Product Manager - Claims Management

    Waystar (Louisville, KY)
    **ABOUT THIS POSITION** This role reports to a Director , Product Management and work closely with User Experience team and Technology teams. The Sr. Product Manager ... reports, and assessing strengths and weaknesses of competitors + Studying healthcare industry standards and staying up-to-date on industry changes and compliance… more
    Waystar (08/08/25)
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  • Medical Director - Care Plus - Florida

    Humana (Montpelier, VT)
    … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... The Medical Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records,… more
    Humana (06/28/25)
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  • Medical Director - NorthEast Region

    Humana (Bismarck, ND)
    … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the appropriateness of services… more
    Humana (07/25/25)
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  • System Director of Risk Management - RN

    Community Health Systems (Naples, FL)
    The **System Director of Risk Management** is a key leader responsible for overseeing risk management, patient safety, and regulatory compliance across Physicians ... Regional Healthcare System. This role ensures compliance with federal, state,...collaborate with one to support quality and safety initiatives. ** Claims & Litigation Management** + Oversee legal claims more
    Community Health Systems (06/28/25)
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  • Assistant Director

    University of Colorado (Denver, CO)
    **Assistant Director ** **Description** **Join Our Team and Make a Difference in Higher Education!** **Position Summary:** **Where You Will Work:** **Equal ... **Duties & Responsibilities:** + Support and collaborate with the URM Director (s) as needed. + Assist with overseeing, facilitating, and developing services… more
    University of Colorado (07/18/25)
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  • Associate Director , Commercial Data…

    Otsuka America Pharmaceutical Inc. (Princeton, NJ)
    **Job Summary** The Associate Director of Commercial Data Science, CNS, will play a pivotal role in driving data-driven decision making to enhance marketing strategy ... and brand performance. The Associate Director will work closely with cross-functional teams, including Marketing, Commercial Operations and Market Access, to ensure… more
    Otsuka America Pharmaceutical Inc. (06/04/25)
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  • Medical Director , Global Medical Affairs,…

    J&J Family of Companies (Raritan, NJ)
    At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, ... we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact… more
    J&J Family of Companies (08/12/25)
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  • Director of Revenue Cycle

    Ophthalmic Consultants of Boston (Plymouth, MA)
    …passionate about revenue cycle innovation, team development, and operational excellence in a complex healthcare environment. Why Join OCB? OCB has a longstanding ... Join a Leader in Eye Care: Director of Revenue Cycle & Billing at Ophthalmic...hands-on leader ready to take charge of high-volume, multi-department healthcare operations? Ophthalmic Consultants of Boston (OCB), a nationally… more
    Ophthalmic Consultants of Boston (07/31/25)
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  • Associate Director , Performance Analytics

    Evolent (Tallahassee, FL)
    …Management** and **Product Management** , leveraging advanced analytics to solve complex healthcare challenges and support impactful decision-making that ... Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing… more
    Evolent (07/15/25)
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  • Senior Director , Clinical Risk Management…

    Banner Health (Phoenix, AZ)
    …including a minimum of three years management level experience within a healthcare system setting or large multi-operational, complex corporate environment. ... skills. Juris Doctor and/or professional clinical degree and experience with healthcare professional liability claims management. Additional related education… more
    Banner Health (05/21/25)
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