- CVS Health (Lansing, MI)
- …compassionate. And we do it all with heart, each and every day. **Position Summary** The ** Senior Claims Benefit Specialist ** will review and adjust SF ( ... ), FI ( _fully insured_ ), Reinsurance, and/or RX claims . They will adjudicate complex, sensitive, and/or specialized ...every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our… more
- CVS Health (Lansing, MI)
- …handle customer service inquiries and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication ... day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject… more
- Corewell Health (Farmington Hills, MI)
- …- 4 times per year. Join our team at Corewell Health as an RN Clinical Risk Specialist Senior and play a pivotal role in shaping the future of healthcare quality ... of patient related injuries and manage the resolution of pre-notice claims . Essential Functions + Reviews and provides recommendations regarding the development… more
- Stryker (Portage, MI)
- Stryker is hiring a ** Senior ** **Staff Clinical Evaluation Specialist ,** this position is **Remote** , supporting our **Instruments Division** . Preference will ... in the Eastern and Central locations of the United States. As a Senior Staff Clinical Evaluation Specialist , you will work closely with cross-functional… more
- Molina Healthcare (Grand Rapids, MI)
- …experience (call center, appeals or claims environment). + Health claims processing background, including coordination of benefits , subrogation, and ... complaints from Molina members, providers and related outside agencies. + Research claims appeals and grievances using support systems to determine appeal and… more
- Molina Healthcare (Grand Rapids, MI)
- …accurate and timely maintenance of critical provider information on all claims and provider databases. Responsible for contracting/re-contracting of standard deals, ... negotiations. Minimal ongoing engagement after contract. Synchronizes data among multiple claims systems when applicable, and the application of business rules as… more
- Prime Therapeutics (Lansing, MI)
- …+ MISCELLANEOUS DUTIES: + Provide backup support to team members (SIU Coordinator and Senior SIU Specialist ) in the performance of job duties as assigned. + ... drives every decision we make. **Job Posting Title** SIU Specialist - Remote in the California market **Job Description**...Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the… more
- Adecco US, Inc. (Lowell, MI)
- …life insurance, short-term disability, additional voluntary benefits , EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees ... have the ability to review and comprehend contracts, process and record warranty claims data with integrity, and accept additional work load as delegated. The ideal… more
- Henry Ford Health System (Detroit, MI)
- GENERAL SUMMARY: Under minimal direction, the Quality/Risk Specialist (QRS) II supports the effective surveillance, analysis, and prevention of events which may ... injure patients, lead to malpractice claims , and cause loss to the health care system....with preparation of periodic status reports for review by senior leadership. + Mentors /teaches root cause analysis (RCA)… more
- Highmark Health (Lansing, MI)
- …months in either Life Office Management Association (LOMA) Certified Employee Benefit Specialist (CEBS), or America's Health InsurancePlans (AHIP) **Language ... structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The...employee groups, or past claim experience to determine what benefits can be offered and to set the rates.… more
- Highmark Health (Lansing, MI)
- …twelve months in either Life Office Management Association (LOMA) Certified Employee Benefit Specialist (CEBS), or America's Health Insurance Plans (AHIP) ... structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The...employee groups, or past claim experience to determine what benefits can be offered and to set the rates.… more
- Medtronic (MI)
- …articulate to customers. + Execute engaging field sales and clinical specialist field education programs that are targeted, purposeful, and support electrophysiology ... Clinical Expert + Translates complex technical messaging, dispels competitive claims , resolves complex technical issues, and maintains customer relationships through… more