- Commonwealth Care Alliance (Worcester, MA)
- 023430 Clin Alli-Clin Assessment & CP **Position Summary:** Commonwealth Care Alliance's (CCA) Assessment unit conducts initial and ongoing face-to-face assessments ... and unmet needs. This individual works collaboratively with other members of the care team and staff in other departments as needed to support timely interventions… more
- Lincoln Financial (Boston, MA)
- …**Requisition #:** 74647 **The Role at a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence team supporting ... coaching and development to perform in this fast-paced environment. As a Claims Customer Care Associate , you will be responsible for answering claimants… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this ... time._** **Position Summary:** Reporting to the Director, Claims Operations and Quality Assurance, the Claims ...have):** + N/A **Desired Education (nice to have):** + Associate 's or Bachelor's degree in Health Administration, Finance, or… more
- Zurich NA (Boston, MA)
- …you. Overview: + Monitor business processes to identify opportunities for customer care 's improvements. + Handle first and third-party claims taking ... Auto Claims Call Center Senior Represent 127692 Zurich is...area OR + Zurich Certified Insurance Apprentice including an Associate Degree and No prior experience required in the… more
- Humana (Boston, MA)
- …and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs ... of decisions to internal associates, and possible participation in care management. May occasionally participate in discussions with external physicians… more
- CVS Health (Boston, MA)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... 5:00 PM Eastern Standard Time (EST)_ The Transition of Care Coach is responsible for care coordination...advocate for themselves. The TOC team will review prior claims to address potential impact on current case management… more
- Evolent (Boston, MA)
- …a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to ... a mission with a company behind it. **What You'll Be Doing:** ** Associate Director, Performance Analytics - Oncology & Member Product Focus** **Overview:** Evolent… more
- Evolent (Boston, MA)
- …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...our specialty programs and administrative platform. Role Overview The Associate Director role on Client Analytics will support both… more
- Baystate Health (Springfield, MA)
- **Summary:** Responsible for wide array of legal functions of large health care system including, but not limited to, advising administration and senior management, ... and others in the development of procedures regarding issues surrounding patient care and treatment. **6)** Determines when court intervention is appropriate and/or… more
- Sanofi Group (Cambridge, MA)
- **Job title** : Associate Director, Brand Analytics (Rhinology, Gastroenterology, Allergy) **Location** : Cambridge, MA **About the Job** Ready to push the limits of ... from Sanofi hubs to optimize process excellence and efficiency The ** Associate Director, Brand Analytics - Rhinology, Gastroenterology, Allergy** will be responsible… more
- CVS Health (Wellesley, MA)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... the Real-World Data tools, including Common Data Models (CDMs). The Senior Associate Epidemiologist / Senior Data Scientist role will support analytical, and… more
- Walgreens (Danvers, MA)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- WTW (Boston, MA)
- …management program design, pharmacy solutions, disability/absence management strategies and claims audit services. Product based solutions such as our pharmacy ... round out our broad-based suite of offerings. As an Associate Director - Sales and Account Management - in...coverage), Dental, Vision, Health Savings Account, Commuter Account, Health Care and Dependent Care Flexible Spending Accounts,… more
- Takeda Pharmaceuticals (Boston, MA)
- …Global HTA and reimbursement landscape and the evidentiary needs of health care decision-makers to guide HE strategies Communication/Publication: + Ensure the drug's ... at LOC level Decision-making and Autonomy + Responsibility in line with Associate Director level position; independently lead HE projects and support the Global… more
- Lawrence General Hospital (Lawrence, MA)
- POSITION SUMMARY The Chief Compliance Officer and Associate General Counsel provides strategic leadership of the organization's compliance program while serving as a ... state healthcare laws and regulations, including Stark Law, Anti-Kickback Statute, False Claims Act, HIPAA, and other fraud, waste, and abuse regulations + Drafting,… more
- Takeda Pharmaceuticals (Boston, MA)
- …to the best of my knowledge. **Job Description** **About the role:** The Associate Director/Lead, US Solid Tumor Forecasting will lead US forecasting activities for ... as a business partner + Knowledge of secondary data sets including claims , EMR, specialty pharmacy data required + Advanced Excel modeling experience required;… more
- Intermountain Health (Boston, MA)
- **Job Description:** Provides extraordinary care to our customers through friendly, courteous, and professional service through a broad understanding of account ... + Perform other duties as assigned **Skills** + Insurance Claims + Medical Billing + Explanation of Benefits (EOB)...hourly rate dependent upon experience. $18.81 - $27.45 We care about your well-being - mind, body, and spirit… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …a dedicated coding specialist reviewing medical records to identify instances of health care fraud, waste, and abuse and to facilitate accurate claim payments. The ... Prepayment Review Coding Specialist will conduct pre-payment reviews of claims submitted by providers and members to determine if...and adjudication by health insurers + Knowledge of health care delivery systems with an emphasis on medical and… more
- Humana (Boston, MA)
- …**Required Qualifications** + Three or more years work experience reading and interpreting claims within a managed care /health care environment + Familiarity ... anomalies in data to identify and collect overpayment of claims . Contributes to the investigations of fraud waste and...are Monday-Friday, 8 hours/day, and 5 days/week in the associate 's home time zone. Some schedule changes/adjustments might be… more
- Beth Israel Lahey Health (Charlestown, MA)
- …Third Party Payer audits by obtaining information relative to all claims audited with regards to policies, departmental practices/processes, and procedures; to ... to the audits in order to prove medical necessity and level of care were warranted in these cases. **Job Description:** **Essential Duties & Responsibilities**… more
