- Wittenberg Weiner Consulting LLC (Santa Fe, NM)
- …attention to detail and adherence to FEMA guidelines. Claims Reviewers - Senior ( Team Lead) will objectively review , investigate, process, evaluate ... Copperhead is seeking multiple Claims Reviewers - Senior ( Team Leads) for a potential contract to support disaster relief. This position involves receiving,… more
- Serco (NM)
- **Position Description** We are looking for a skilled Disaster Claims Reviewer to join our team . The successful candidate will leverage their five years of ... managing disaster claims efficiently. **As a Disaster Claims Reviewer , you will:** + Assist in...by promptly addressing and resolving inquiries related to property claims . + Collaborate with team members and… more
- Serco (NM)
- **Position Description** We are looking for a skilled and detail-oriented Claims Appeals Specialist to join our team . The successful candidate will have at least ... to added data & documentation from the claim appeals.* Review appeals information and reassess the claims ...service by addressing and resolving inquiries related to property claims .* Collaborate with team members and external… more
- Serco (NM)
- **Position Description** We are seeking an experienced Disaster Claims Project Manager, who will bring extensive in disaster-related claims and planning. With ... over five years of experience in claims processing and evaluation, the ideal candidate will excel...interested in supporting and working with a passionate Serco team - then submit your application now for immediate consideration.… more
- Serco (NM)
- **Position Description** Join our dynamic team as a Claims Quality Control Specialist, where your expertise will contribute to effective disaster claim ... You will leverage your NFIP Certification and robust experience in claims evaluation to navigate complex federal policies while maintaining exceptional standards… more
- General Motors (Santa Fe, NM)
- …and Service Agreement. This review may include dealership practices relative to warranty claims and policy claims . These claims must comply with specific ... Specific responsibilities include: * Determining the compliance of these claims with the rules and policies * Constructing a...employee to feel they belong to one General Motors team . **Benefits Overview** From day one, we're looking out… more
- Humana (Santa Fe, NM)
- …part of our caring community and help us put health first** The Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... focus of this role is Medicare Pharmacy and Part D. The Senior Compliance Professional will analyze business requirements, provide research and regulatory… more
- Cardinal Health (Santa Fe, NM)
- …as a primary liaison and expert on the business in support of the Litigation team . + Advises business unit leaders on terms, risks and due diligence during mergers ... laws and regulations, including the Anti-Kickback Statute, the False Claims Act, Stark Law, HIPAA and other laws applicable...business clients + Working under the general supervision of senior attorneys and exercising sound judgment as to matters… more
- Cardinal Health (Santa Fe, NM)
- …and enhance the overall healthcare experience. We are seeking a highly motivated and experienced Senior Data Scientist to join our team as a thought leader and ... ensuring alignment with our overall business objectives. + Guide and mentor a team of Data Scientists and ML Engineers by providing technical guidance, mentorship,… more
- Highmark Health (Santa Fe, NM)
- …quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of ... questionable claim patterns of renewal clients and issues with competitor's claims experience for prospect clients and develops recommendations to account for… more
- Mass Markets (Las Cruces, NM)
- …we need your help in managing call center customer service agents. While your team operate the phone for a variety of commercial, state, and federal projects, you ... support them with your leadership and expertise. As the team coach and leader, you will be directly responsible...productivity of direct reports + Responsible for weekly payroll review and submission to ensure correct entries + Responsible… more
- Molina Healthcare (NM)
- …to technical system enhancements by performing user testing.* Participate as a team player by assisting peers and Management to support department goals.* Trains ... party administrators. + Performs enrollment functions to include call tracking, claims workflow, and encounter requests for verification and updates, PCP assignment… more
- TXNM Energy (Albuquerque, NM)
- …making to ensure the adequacy of insurance coverages, appropriate handling of claims , credit risk monitoring and approvals and the ERM program.. ESSENTIAL DUTIES ... documentation for internal, external and policy audits Serve as Risk Management team backup for internal customers for reporting of potential liability claims… more
- Prime Therapeutics (Santa Fe, NM)
- …Solution Strategist for our NEW JUDI program. If you have experience with PBM/health claims , love working in a fast-paced environment within a group that has a ... you would be responsible for partnering with cross functional stakeholders and senior leaders to implement innovative solutions that advance or achieve Prime's… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …our core business and stakeholders. The Global Integrated Evidence & Innovation team works to achieve these goals by supporting integrated evidence planning, ... a Director to support both Global Integrated Evidence and Digital Health R&D team . The successful candidate will collaborate closely with, and/or be a critical… more
- Prime Therapeutics (Santa Fe, NM)
- …support conclusions and recommendations. + MISCELLANEOUS DUTIES: + Provide backup support to team members (SIU Coordinator and Senior SIU Specialist) in the ... results with limited supervision. + Demonstrated strategic and analytical abilities to review and evaluate information such as claims data, suspicious patterns… more
- Prime Therapeutics (Santa Fe, NM)
- …make. **Job Posting Title** Sr. Market Pricing Analyst - REMOTE **Job Description** The Senior Market Pricing Analyst serves as a trusted partner to our health plan ... revised financial pricing strategies based on analysis of pharmacy claims data, average wholesale drug prices (AWP), health plan...pricing data + Collaborate with sales and account management team as well as other internal functional areas to… more
- Molina Healthcare (NM)
- …& health plans (eg product, configuration, UM, Care Management, provider network, claims ) for requirements planning * Makes recommendations on scope and priorities ... use by Molina * Conducts or coordinates post-implementation initiative review to measure results and report to health plan...to measure results and report to health plan partners, senior management & stakeholders * Provides summary analysis of… more
- Customs and Border Protection (Artesia, NM)
- …Step 10). In this position, you will become a key member of the legal team for The Office of The Chief Counsel. Typical work assignments include: Developing and ... or conflict with performance of your official duties. Please review further details via the following link. DHS uses...payment amount will be your responsibility, and no subsequent claims for relocation expenses will be granted by CBP.… more
- Walgreens (Albuquerque, NM)
- …experience. + Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including ... pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient… more