- Lincoln Financial (Providence, RI)
- …**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
- Humana (Providence, RI)
- …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
- Evolent (Providence, RI)
- …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 (Providence, RI)
- …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
- Travelers Insurance Company (Providence, RI)
- **Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our ... Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to… more
- Walgreens (Warwick, RI)
- …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
- South County Hospital (Wakefield, RI)
- …a health care setting or with a provider of services to the health care industry, or + Associate degree or equivalent from an accredited college plus seven ... new employees, and other staff to promote patient safety and minimize claims exposure. + Provide on-call support and timely consultation on risk-related issues… more
- Humana (Providence, RI)
- …community and help us put health first** Design and maintain Medicaid claims analytics dataset using Databricks. Conduct in-depth analysis of healthcare claims ... Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. Maintain dashboards to communicate key trends to stakeholders. The… more
- Humana (Providence, RI)
- …looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and ... provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters… more
- Humana (Providence, RI)
- …achieving operational and compliance key performance indicators. In addition, the associate will participate in cross functional teams and support analyzing business ... an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and… more
- Humana (Providence, RI)
- …have expertise in conducting retrospective observational studies using administrative claims data using a collaborative approach across multiple stakeholders. Humana ... + An understanding of research methodology and the managed care arena, and how it applies to health outcomes...with cloud base analytics platforms + Experience with clinical, claims , pharmacy or other healthcare data. + Strategic thinking… more
- Humana (Providence, RI)
- …of the Pharmacy Analytics division, with responsibilities that include working with pharmacy claims data. The team to which this position reports is dedicated to ... PowerBI + Experience in Databricks is preferred + Experience in analyzing pharmacy claims data Travel: While this is a remote position, occasional travel to Humana's… more
- Humana (Providence, RI)
- …complete and accurate. + Certified Professional Coder or coding knowledge. + Claims knowledge and understanding of claims processing. **Additional Information** ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more
- Humana (Providence, RI)
- …health first** **Requires a strong foundation in COBOL mainframe development ** The Claims Adjudication System (CAS) team at Humana is essential in delivering core ... services through effective claims processing and management solutions. This position involves coding software applications based on business requirements and… more
- Highmark Health (Providence, RI)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy technician ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- UMB Bank (Providence, RI)
- …insurance coverage through Bank's blanket program or external policy, facilitate insurance claims , taxation matters and payment, and that assets are reviewed in ... other insurance coverage; health savings, flexible spending, and dependent care accounts; adoption assistance; an employee assistance program; fitness reimbursement;… more
- Humana (Providence, RI)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Walmart (Providence, RI)
- …Facilities requesting replacement HVACR equipment for facilities submitting warranty claims reviewing journals and invoices conducting price comparisons of ... Individual: Demonstrates and encourages respect for others drives a positive associate and customermember experience for all embraces differences in people cultures… more
- Humana (Providence, RI)
- …Qualifications** + 2+ years of experience servicing or negotiating managed care contracts with physician, hospital and/or other provider contracts + Proficiency ... **Preferred Qualifications** + Bachelor's Degree + Experience working with medical claims + Experience with ACO/Risk Contracting + Experience with Value Based… more
- Humana (Providence, RI)
- …office applications (Word, Excel, Outlook) **Preferred Qualifications** + 1+ years of claims experience + 1+ years of Medicare and/or Medicaid experience + MHK ... Job Experience (VJE). This is an online activity where you will learn more about Customer Care jobs at Humana, try out some of the most common job tasks, and tell us… more