- 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
- Otsuka America Pharmaceutical Inc. (Providence, RI)
- …Otsuka Precision Health is a health experience company that brings personalized care within reach through products and services for mental and physical well-being. ... **About This Role** We are seeking a strategic, entrepreneurial Associate Director to drive the evolution of OPH's connected...solutions that enhance peoples' lives, we also work to care for our teammates' professional and personal growth and… 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
- 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
- Walgreens (Johnston, 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
- Highmark Health (Providence, RI)
- …is responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… 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
- Humana (Providence, RI)
- …this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus ... and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and… more
- Otsuka America Pharmaceutical Inc. (Providence, RI)
- …Specialty Medicine products at different stages of development for a global health- care market. The specific duties assigned to the Director, Global Clinical ... research experience (as a general guideline, 1-3 years for Associate Director level; 3-6 years for Director and 6-9...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Humana (Providence, RI)
- …to assignments. The Senior Encounter Data Management professional ensures data integrity for claims errors that result from the data exchange between Humana and its ... to make an impact** **Required Qualifications** **5 years of medical claims processing/auditing or encounter data management experience** **Demonstrated deep dive… more
- Humana (Providence, RI)
- …responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Humana (Providence, RI)
- …The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work assignments are ... make an impact** **Required Qualifications** + 1 - 5 years or more of claims processing experience + Minimum of 1 year experience in conducting thorough root cause… more
- Humana (Providence, RI)
- …populations served in target growth markets. Candidates will possess Medicaid managed care operations expertise and have experience in designing solutions for key ... member, products and benefits, and health plan administration portfolios (provider, claims , etc.), with areas of focus including Enrollment, Member Experience,… 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)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of ... + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate… more
- CVS Health (Providence, RI)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... Summary** The Negotiator Analyst is responsible for negotiating out-of-network (OON) medical claims valued at $10,000 and above. This role involves learning the… more
- Humana (Providence, RI)
- …The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on problems of ... years of established, post-residency clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be… more
- Humana (Providence, RI)
- …point of sale to members loaded in system, ID cards issued, claims opened for processing and certifications issued. The Senior Installation Administration ... (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)
- …of coverage + Experience in negotiation + Experience working with healthcare or claims related data Travel: While this is a remote position, occasional travel to ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more