- APTIM (Santa Fe, NM)
- **Summary:** The Subject Matter Expert (SME) provides specialized technical expertise in support of claims review, evaluation, and documentation for ... losses, damages, repairs, and replacement costs in line with subject matter areas of expertise. + Customer...FEMA staff, and other stakeholders. + Proficiency in using claims management software, databases, and other technology tools that… more
- Cardinal Health (Santa Fe, NM)
- …states on paper and online. + Mails all paper claims . + Acts as a subject matter expert in claims processing. + Manages billing queue as assigned in ... done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as… more
- Sedgwick (Santa Fe, NM)
- …directs the handling to achieve the best possible resolution. + Acts as the organizational subject matter expert for line of business and key jurisdictions ... Specific jurisdictional expertise preferred. **Skills & Knowledge** + Subject matter expertise in worker's compensation claims and/or liability claims… more
- Lincoln Financial (Santa Fe, NM)
- …at a Glance** As an Appeals Specialist you will be responsible for being a product subject matter expert to provide full, fair appeal reviews for multiple ... product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will analyze and… more
- Prime Therapeutics (Santa Fe, NM)
- …& Home Delivery Program Claims Analyst is responsible for serving as a subject matter expert on our Home Delivery and Specialty pharmacy partners ... mentoring resource for inquiries and issues. **Responsibilities** + Represent Strategic Partnerships as subject matter expert (SME) on both internal and… more
- Sedgwick (Santa Fe, NM)
- …or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | Multi-Line | Public Entity | Remote...the same assisting our public entity clients with their claims ! If you are an agile multi-line examiner with… more
- Sedgwick (Santa Fe, NM)
- …or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | General Liability BI | Captive |...General Liability BI | Captive | Remote As a Claims Examiner at Sedgwick, you'll have the opportunity to… more
- CVS Health (Santa Fe, NM)
- …do it all with heart, each and every day. **Position Summary** This position will be the claims subject matter expert , as well the primary resource for ... operations unit. The position will also act as the technical liaison between the claims operations area and other areas within the company that impact operations day… more
- Prime Therapeutics (Santa Fe, NM)
- …assigned projects + Provide leadership and serve as subject matter expert and mentor for other members of Claims IT team, including cross-training ... to elicit, define, and document the requirements for changes to Prime's claims systems. **Responsibilities** + Ensure understanding of business requirements and IT… more
- Zurich NA (Santa Fe, NM)
- …complex new and renewal domestic Energy Oil, Gas & Power Gen accounts and serve as a Subject Matter Expert on the team. As a member of Zurich's Underwriting ... and 10 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance...set at 20%. As an insurance company, Zurich is subject to 18 US Code | 1033. A future… more
- Evolent (Santa Fe, NM)
- …cost & use and make recommendations based on relevant findings + Serving as a subject matter expert across multiple technical and/or business domains **The ... mathematics, economics) + At least 3-5 years of professional experience in claims -based healthcare analytics with a payer, provider, clinical vendor, managed care,… more
- Sedgwick (Santa Fe, NM)
- …& Insurance Program Implementation Advisor **PRIMARY PURPOSE** **OF THE ROLE** To serve as the subject matter expert (SME) of a single line of business; ... combination of education and experience required to include two (2) years of claims management, managed care or other related experience. **Skills & Knowledge** + In… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …available evidence across cross-functional teams and identify best practices. + Serve as a go-to subject matter expert for a strategic point of view on the ... evidence generation, specific challenges, or marketplace dynamics. + Provide expert scientific feedback on study concepts and study protocols...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …by external partners. + **Key Responsibilities:** + Serve as the primary technical subject matter expert (SME) for downstream processing (chromatography, ... including documentation review, gap analysis, and risk assessment. + Provide expert technical oversight of downstream manufacturing operations at CDMOs, including… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …publications within the assigned disease areas in psychiatry and neurology. Act as a subject matter expert , providing medical and scientific insights to ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- CVS Health (Santa Fe, NM)
- …specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to ... customer service inquiries and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority… more
- Molina Healthcare (Santa Fe, NM)
- …to ad-hoc data analyses, development, and presentation of financial reports + Serve as subject matter expert on developing financial models to evaluate the ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Molina Healthcare (Santa Fe, NM)
- …and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert by working with the less complex and lower ... **Job Description** **Job Summary** Supports ongoing Claims and Enrollment operations in the management of smaller scale, less complex vendor activities. Provides… more
- Highmark Health (Santa Fe, NM)
- …business partners, internal departments and external clients. + Represent department as the Subject Matter expert . + Pull and research necessary ... August 2016. + Experience in Provider Data Management, Customer Services or Claims . + Microsoft office experience (ie Word, Excel, PowerPoint, etc.) **Preferred** +… more
- Molina Healthcare (Santa Fe, NM)
- …issues that may cross departmental lines and involve Senior Leadership. + Serves as a subject matter expert for other departments. + Trains other Provider ... Requires an in-depth knowledge of provider services and contracting subject matter expertise. + Resolves complex provider...3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5… more