- Robert Half Legal (Farmington Hills, MI)
- …A prominent Michigan-based organization in the insurance sector is looking for a dynamic Claims Director . This position is ideal for an experienced leader with ... expertise in claims management, litigation oversight, and operational strategy. *This is...to ensure accuracy and compliance. + Support the executive director and collaborate with leadership on organizational strategy and… more
- Zurich NA (Detroit, MI)
- Executive Underwriter OR AVP, Underwriting Director - Contract Surety 124610 Zurich North America is currently looking for a Contract Surety Underwriter **to join our ... filled at either the Executive Underwriter OR AVP, Underwriting Director - Contract Surety officer level. The hiring manager will...and 10 or more years of experience in the claims or underwriting support areaOR + Zurich approved Apprenticeship… more
- Molina Healthcare (Detroit, MI)
- **Job Description** **Job Summary** The Network Solutions Director is responsible for leading a team designing and executing new solutions. The position requires the ... lead a diverse team of technical experts and business analysts. The Solutions Director will interface with IT and business leaders to enable enterprise wide… more
- Molina Healthcare (Detroit, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... the development, implementation and maintenance of provider data in the claims payment system. * Supports critical business strategies by providing systematic… more
- Molina Healthcare (Detroit, MI)
- …activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- Ford Motor Company (Dearborn, MI)
- …best. **In this position ** We are seeking an experienced and strategic Director , Health Care Benefits to lead the design, evolution, and administration of Ford's ... + Experience with self-insured health plans, actuarial valuation processes, and claims analytics. + Experience in the automotive, manufacturing, or other heavily… more
- Molina Healthcare (Detroit, MI)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Corewell Health (Southfield, MI)
- …activities such as personnel file requests, subpoena responses, unemployment claims processing, internet usage reporting, internal review processes, exit interviews, ... team member qualifications including health requirements, regulatory audits, team member investigations, verifications of employment, etc. + From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course… more
- Wayne State University (Detroit, MI)
- …oversight of the self-insurance workers' compensation program and assist the Associate Director of ERM in the administration of the Certificate of Insurance Program ... Self-Insurance Corporation (MUSIC) core contracts. This position reports to Senior Director of Enterprise Risk Management & Insurance Programs. Essential Functions… more
- Guidehouse (Detroit, MI)
- …remote **What You Will Do** **:** + Under the direction of the Director of Revenue Integrity, the Revenue Integrity Coding Billing Specialistprovides revenue cycle ... plan when needed + Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold… more
- R1 RCM (Detroit, MI)
- …+ Review and apply client contract language and rates to resolve denied claims . + Utilize payer-provider and administrative manuals to dispute denied claims . ... Internal High Balance Meeting Calls for their assigned areas and/or providing to the Director a full report prior to these meetings on the status of accounts… more
- Elevance Health (Dearborn, MI)
- …service as required. + Conduct business in a professional manner. + Troubleshoot claims issues. + Investigate and research to resolve customer complaint problems and ... required licensure activities supervised by the Clinical Manager or Clinical Director . **Preferred Qualifications:** + Experience in settings that include inpatient,… more
- AmeriHealth Caritas (Detroit, MI)
- …authorizations, including home- and community-based programs. + Collaborate with the Medical Director and care team to develop and monitor treatment plans. + Address ... service issues and assist with provider or claims -related problem-solving. + May oversee tasks assigned to other licensed or unlicensed professionals involved in… more
- Henry Ford Health System (Detroit, MI)
- …analysis, and prevention of events which may injure patients, lead to malpractice claims , and cause loss to the health care system. The QRS II collaborates ... leads root cause analysis (RCA) investigative team; in collaboration with director , prepares RCA for presentation to leadership. + Facilitates or co-facilitates… more
- Danaher Corporation (Detroit, MI)
- …engagement and responding to customer inquiries. This position reports to the Senior Director Market Access Americas and is part of the Value and Access team. ... coding and reimbursement. + Support customers with approved resources for denied claims , payer coverage expansion and inadequate reimbursement. + Respond to and… more
- Select Medical (Ypsilanti, MI)
- …the Human Resources department in coordination with the regional Human Resources Director and the corporate Human Resources team, payroll department and recruitment ... and/or compliance purposes. + Processing and maintaining all workers' compensation claims , unemployment requests, FMLA and leaves of absences. + Providing services… more