- AmeriHealth Caritas (Manchester, NH)
- ** Provider Network Operations Claims Analyst Sr (hybrid)** Location: Manchester, NH Primary Job Function: Provider Network ID**: 34151 **Job ... Brief** The Provider Network Operations Data Analyst Sr. will be...reviews requests prior to initial submission to EO and claims post-production + Capitation reconciliations - building queries, comparing… more
- Prime Therapeutics (Boston, MA)
- … Claims Auditor is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting ... to drive timely and accurate documentation receipt and review + Analyze pharmacy claims to identify those at the highest risk for error; utilize analytics and… more
- Elevance Health (Woburn, MA)
- …miles/1 hour commute to one of our Elevance Health Main offices. The ** Provider Operations Director** is responsible for supporting business strategies through ... Provider Strategy & Operations Director (JR113850)...minimum of 7 years of management experience in healthcare operations , network management, enterprise level project management… more
- Commonwealth Care Alliance (Boston, MA)
- …- Prioritize and organize own work to meet deadlines. - Work collaboratively with Provider Network Management staff to ensure an adequate and appropriate ... provider network . Participate in contracting strategy discussions...process highly desired. - Experience with and understanding of Claims operations preferred EEO is The Law… more
- WellSense (Boston, MA)
- …taking the lead and promoting collaboration within Plan, as it relates to provider network maintenance. Manages territory inclusive of one or more of ... provider and internal Plan departments such as Provider Enrollment, Claims , Audit, Marketing, Customer Care...+ Analyzes operational issues with regard to territory and provider operations such that interrelationships among other… more
- HomeSafe Alliance (Boston, MA)
- …operations (property survey, pick up, pack, delivery, unpack, short term storage SIT, claims ). + Provide GHC contract requirements to JPPSO staff and ensure ... more effectively. + Express company concerns and requirements to HomeSafe Alliance operations , claims , quality, and operations excellence staff sections.… more
- Fallon Health (Worcester, MA)
- …related to the development and implementation of processes and workflows, network development, contract management, claims , billing, and authorization ... office staff is able to complete daily billing and claims responsibilities + Works with FH UM, Provider...Department** + Works closely with the Senior Director, PACE Operations to ensure network adequacy and timely… more
- Elevance Health (Manchester, NH)
- …CPA or MBA degree. + Experience with transplant and specialty care contracting/ operations strongly preferred. + Network build experience. + Commercial, Medicare ... **Director Specialty Network Management** **Location:** This position will work a...responses, assists in development of quality criteria, analysis of claims data and implementation of contracting strategy. + Oversees… more
- JPMorgan Chase (Boston, MA)
- …team members as our client base grows. As an IMOS analyst within the IBOR Operations oversight team, you will deal with all stages of the lifecycle for each product ... from broker matching, management of the client's custodial network , lifecycle events including corporate events, ensuring timely settlement of trades and cash,… more
- Elevance Health (Manchester, NH)
- …Belt preferred. + Prior experience with provider network contracting, provider networks, claims , finance, and operations preferred. + SQL experience ... of care improvement processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual… more
- Prime Therapeutics (Boston, MA)
- …programs to meet client's needs based on evaluation of their pharmacy and medical claims data. Provides clinical operations input and support of client specific ... control and monitor project activities. + 5+ years' experience in clinical operations , quality, network , pharmacy or project management. + Project management… more
- AIG (Boston, MA)
- …organization. Building on 100 years of experience, today AIG member companies provide a wide range of property casualty insurance, life insurance, retirement ... businesses and individuals protect their assets, manage risks and provide for retirement security. Get to know the business...to know the business General Insurance is a leading provider of insurance products and services for commercial and… more
- Sedgwick (Boston, MA)
- …and to maintain relationships with internal and external customers, the provider / network and other members of the vendor community. **ESSTENTIAL ... and implements cost effective strategies promoting productive outcomes for Bill Review operations . + Ensures quality performance of the bill review product to… more
- Tufts Medicine (Boston, MA)
- …Profile** **Summary** This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this ... duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted … more
- Commonwealth Care Alliance (Boston, MA)
- …of health plan operations including utilization and care management, claims processing, contracting and provider relations and regulatory compliance. ... high functioning and medically appropriate, including care management, health plan operations , quality improvement, and HEDIS. The incumbent will also contribute to… more
- State of Massachusetts (Haverhill, MA)
- …Contract related mass retro payment calculations. * Ability to process Worker's Compensation claims and provide any necessary follow-up. * Serve on college ... a Leader College in Achieving the Dream, a national network of community colleges dedicated to using data to...HR processes. The HR Generalist will support the daily operations including extremely sensitive situations and information which will… more
- Bank of America (Boston, MA)
- …systems such as Excel, SAS, SQL, Tableau, and other relational data bases to provide analytical support on strategies, ensure goals are met, and propose policy and ... risk controls are deployed adhering to best practices. Team member will provide recommendations on mitigation efforts, ensuring monitors are in place, self-create… more
- Bank of America (Boston, MA)
- …controls are deployed, while adhering to best practices. Team member will provide recommendations on mitigation efforts, ensuring monitors are in place, and will ... providing fraud requirements, testing, and development of strategies. Projects include network mandates, Product team support, and internal projects. Several key… more
- HUB International (Boston, MA)
- …with cross-functional teams including Business Development, Relationship Management, Operations , Sales Enablement, IT, Corporate Strategy, Marketing, and End ... prioritize initiatives, and drive alignment on CRM initiatives. + Provide regular reporting and insights to stakeholders. + Stay...commissions for some positions. **WHY CHOOSE HUB?:** Throughout our network of more than 530 HUB offices in North… more
- HUB International (Burlington, MA)
- …ensure seamless delivery and implementation of financial wellness programs. + Provide product demonstrations, presentations, and training sessions to HUB employee ... hundreds of thousands of retirement plan participants, individuals, and institutions. We provide financial piece of mind and top of class solutions, investments,… more