- 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 (Warren, 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
- Sedgwick (Detroit, MI)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance Marketing Technology Director **PRIMARY PURPOSE OF THE ROLE:** The Director , Marketing ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- Henry Ford Health System (Troy, MI)
- …to meet urgent Part D and pharmacy analysis needs. This new Director role establishes dedicated, in-house pharmacy actuarial expertise to strengthen financial ... position HAP for competitive advantage in 2026 and beyond. Position Summary The Director , Actuarial Services - Pharmacy / Part D is responsible for leading all… more
- Molina Healthcare (Warren, 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 (Warren, 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
- Molina Healthcare (Warren, 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
- Molina Healthcare (Warren, 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
- Molina Healthcare (Warren, MI)
- …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
- Molina Healthcare (Warren, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems ... leadership based on feedback rom assigned MHI attorney. * Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting. * Advises… 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
- 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