- Sedgwick (Austin, TX)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Director Complex Claims **PRIMARY PURPOSE** **:** To be responsible for ... managing SIU investigations of complex fraud schemes involving providers, vendors, attorneys and others;...degree from an accredited college or university preferred. Fraud Claims Law Associate (FCLA), Certified Insurance Fraud Investigator (CIFI),… more
- Humana (Austin, TX)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to … more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …Founded on Otsuka's rich history in delivering breakthrough innovations to solve complex problems for patients, Otsuka Precision Health (OPH) is the next step ... health experience, one connection at a time, together. The ** Director , Digital Health Corporate Counsel** will be responsible for...with other members of the OPH Legal team on complex matters and matters of first impression, as well… more
- Evolent (Austin, TX)
- …to ensure clean and consistent tracking of Evolent's covered membership and claims + Synthesize complex analyses into succinct presentations for communication ... providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and...connected care journey. We are hiring for a Senior Director to join our Finance Team. The candidate selected… more
- Humana (Austin, TX)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... The Medical Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records,… more
- Humana (Austin, TX)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... The Medical Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records,… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- The Associate Director , Brand and Sales Analytics will be part of a high performing team that provides actionable, innovative solutions to address key business ... questions & opportunities. The Associate Director , Sales & Marketing Analytics should be able to...and effectively with limited supervision, while working across a complex matrix environment that includes areas in marketing, sales,… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …Specialty Pharmacy operations for OAPI The position will report to the Executive Director , Channel Strategy and Patient Affordability We are seeking a highly skilled ... and motivated Director of Specialty Pharmacy Operations to lead and oversee...diverse teams and stakeholders. + Demonstrated ability to manage complex projects, prioritize tasks, and meet deadlines. + Knowledge… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …medical needs and nutraceutical products for the maintenance of everyday health. As a Director , US Market Access Strategy and Innovation you will be a champion of ... responsible for driving the optimization of Otsuka's understanding and navigation of the complex access landscape and dynamics. Through a wide range of pipeline and… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- Director of Field Reimbursement Management (FRM) Position Overview We are seeking an experienced, transformative leader to serve as the Director of Field ... space + Experience in training and developing teams on complex reimbursement topics + Understanding of the "Buy and...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- The Associate Director , TLL, Renal Rare Disease, is a field-based, customer facing, non-sales position on Otsuka's Rare Renal team focused on enhancing and improving ... present and educate/present to KOLs and customer groups on complex and scientific/clinical information. + Assess and understand KOL...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- The Associate Director , Channel Analytics will be a key member of the Business Analysis team, responsible for leading marketing mix and channel analytics to optimize ... digital, HCP, and DTC strategies. + Ability to translate complex data insights into clear business recommendations. + Strong...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Evolent (Austin, TX)
- …health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek ... insights. We value curiosity, creativity, and independence, working collaboratively to solve complex challenges and enhance the impact of our specialty programs and… more
- Evolent (Austin, TX)
- …humility, adaptability, intellectual curiosity, and accountability as we solve complex business problems. **Collaboration Opportunities:** The Director , ... health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- The Director of Market Access Patient Experience and Reimbursement Analytics is an individual contributor role focused on analyzing and optimizing patient experience ... specialty pharmacy and hub services. + Ability to translate complex data insights into clear business recommendations + Strong...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Sedgwick (Austin, TX)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance Business Development Director **PRIMARY PURPOSE OF THE ROLE:** To facilitate the Company's top line ... + Ten (10) years of relationship building in the claims management or risk management area or equivalent combination...unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see**… more
- Humana (Austin, TX)
- …experience for our associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals), you will be accountable for ... operational efficiencies + Collaborates with upstream business partners such as Claims , Clinical Guidance, and the Provider Network to identify opportunities and… more
- Humana (Austin, TX)
- …Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on problems ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the appropriateness and… more
- CVS Health (Austin, TX)
- …day. **Position Summary** CVS Health is seeking an experienced and innovative Director of AI Solutions Design to lead the development of artificial ... intelligence-driven solutions that address complex process challenges across our healthcare operations. This role...related), and the ability to drive impactful change. This Director will serve as the main point of contact/liaison… more
- Humana (Austin, TX)
- …Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of… more