- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider ... network performance, and ensuring compliance with regulatory standards. The Director drives initiatives that enhance operational engagement, member access, provider… more
- CSL Behring (Waltham, MA)
- We are currently recruiting for an experienced, dynamic and visionary Senior Director of Cardiovascular & Renal Global Commercial Development to join our team. This ... driving early product strategy, Target Product Profiles (TPPs), Target Product Claims (TPCs), Stage-Gate Preparation, and Life Cycle Management (LCM) Planning and… more
- Commonwealth Care Alliance (Boston, MA)
- …management functions with network strategy, vendor relationship management and claims processing. Works closely with provider relations on resolving provider ... related issues. - Directs the work of the utilization management team to ensure quality, interrater reliability and standards are met in daily operations. Responsible for resolution and communication of utilization management issues and concerns and corrective… more
- Commonwealth Care Alliance (Boston, MA)
- …satisfaction and member access to care. Reporting to the Senior , Director of Delegation Partnerships., the Senior Provider Relations Account Manager will: + ... + **Operational Excellence:** + Collaborate with cross-functional teams (eg, Claims , Credentialing, Clinical Care Management, Member Services, Provider Services,… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary** The Program Manager, in collaboration with the Sr Director of Delegation Partnerships and Performance, is responsible for advancing provider ... performance frameworks and value-based care principles. + Working knowledge of claims data, quality measurement, and performance incentive methodologies. + Excellent… more
- Commonwealth Care Alliance (Boston, MA)
- …compliance. The Senior Business Analyst, Clinical Operations reports to the Director , Clinical Operations Support. This role will provide significant BA support ... as, authorizations, assessments, procurement, etc. + Tracks, analyzes and resolves claims issues related to prior authorizations. **Process Improvement** + Partners… more
- Ryder System (Boston, MA)
- …clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **Summary** The Director Claims directs activities within the General and ... third-party provider relationships (including consultants, legal counsel, insurers, and external claims administrators). The Director manages and oversees the… more
- Sedgwick (Springfield, MA)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Business Development Director - Casualty Claims (Northeast Region) As a Business Development ... not required. **Experience:** Ten (10) years of relationship building in the claims management or risk management area or equivalent combination of education and… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
- Commonwealth Care Alliance (Boston, MA)
- …states will not be considered at this time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr. ... of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims ... 011250 CCA- Claims Hiring for One Year Term **_This position...Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and… more
- CenterWell (Boston, MA)
- … Director , Primary Care relies on medical background and reviews health claims . The Medical Director , Primary Care work assignments involve moderately complex ... Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where the… more
- Humana (Boston, MA)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Boston, MA)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Boston, MA)
- …The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- Zurich NA (Boston, MA)
- Senior Professional Liability Claims (Attorney), Claims Construction 128423 **Zurich North America is expanding its nationwide Construction Professional ... Liability Claims Team with the addition of a dedicated ...Working: Yes Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-LC1 #LI- DIRECTOR #LI-HYBRID EOE Disability /… more
- State of Massachusetts (Boston, MA)
- …join our Victim Compensation team. Reporting to theDirector of Victim Compensation,the Claims Manager provides management and oversight of MOVA's Claims ... compensation program in accordance with Massachusetts statute and regulations. The Claims Manager implements trauma informed, victim and survivor centered systems… more
- HUB International (Wilmington, MA)
- …own unique, regional culture. We currently have an opportunity for a **Senior Claims Specialist** . **Overview** : Responsible for servicing assigned accounts on a ... for small, middle market, and high-profile clients by reporting claims . + Participate in the claim after hours program...mentor team associates and training as assigned by Manager/ Director + Attend claim reviews/ meetings with the client… more
- MAPFRE Insurance (Webster, MA)
- …ready to drive innovation and elevate customer experience. **About the Role** As Director , you will: + Lead high-volume, lower-complexity claims teams with a ... Director , Physical Damage (Express/Glass) Date: Nov 15, 2025...Damage (Express/Glass)** to lead our fast-paced Express and Glass Claims Units and oversee post-training deployment for staff entering… more
- Boston Mutual Life Insurance (Canton, MA)
- …+ Leave our customers and associates "better than where we found them." The Director - Claim Services plays a pivotal role within Boston Mutual, responsible for ... managing and overseeing of all aspects of the Claims Service team for Life and Accident Claims . This includes setting strategic direction, managing claims … more
