- buyer (New York, NY)
- …members and providers.Position OverviewClaims Quality Auditor is responsible for reviewing claims to determine if payments have been made correctly. This position ... analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon… more
- buyer (New York, NY)
- …building strong relationships with its members and providers.Position OverviewAs a Claims Adjustment Specialist I, this individual will be responsible for analyzing ... standard to complex post-paid healthcare claims that require in depth research to determine accuracy...research to determine accuracy and mitigate payment errors. The Claims Adjustment Specialist I will also be responsible for… more
- CHRISTUS Health (Tyler, TX)
- …CHRISTUS services. These services will be provided by monitoring cases and claims , analyzing biometric and health risk assessment data, organizing disease management ... programs and proactively interacting with members, physicians and other providers. Incumbent oversees integrated data warehouse including program utilization, disease management programs and contracted provider network support. Responsibilities: Oversee the… more
- UnisLink (Phoenix, AZ)
- …of a growing team with long-term career potential? UnisLink is hiring a Medical Claims Clerk to support our billing and operations teams. No prior medical billing ... will include: Acting as the primary resource for printing and mailing secondary claims and appeals for multiple clients. Handling unprinted claims and ensuring… more
- Hallmark Financial (Dallas, TX)
- Job Description: Position Title: Senior Claims Adjuster (Fast Track- Bodily Injury) Job Summary: Investigates, evaluates, negotiates and resolves claims of ... and interaction with insured's and claimants in accordance to established claims procedures and state regulations. Essential Duties and Responsibilities include the… more
- Neighborhood Health Plan of Rhode Island (Smithfield, RI)
- …Daytime Job Category Professional / Experienced Description The Policy and Claims Research Specialist is responsible for supporting the Payment Integrity initiatives ... as the point of contact for claim related research. Serves as a claims subject matter expert (SME) and handles incoming inquiries regarding Payment Integrity… more
- Formation Bio (New York, NY)
- …curated data assets. You'll partner closely with domain experts in areas like claims , EHR, and biomedical research - ensuring their deep knowledge is translated into ... harmonization across healthcare and pharmaceutical datasets. Partner with domain experts ( claims , EHR, pharma, research) to align technical standards across diverse… more
- Collectors Holdings, Inc. (Santa Ana, CA)
- …Hong Kong, Toronto, Guadalajara, Dallas, and Paris. We're looking for a Claims Investigator to join our Collectors Claimsteam, providing essential assistance to our ... their times of need. Our team's core responsibility revolves around efficiently handling claims for customers who may have encountered damage or loss of their items… more
- Hallmark Financial (Dallas, TX)
- …The Compliance Specialist: Accurately processes monthly compliance review ensuring regulatory compliance. Essential Functions include the following. Other duties may ... be assigned. Process monthly and quarterly SOX compliance control testing. Assist with internal and external compliance audits. Maintain compliance records. Complete additional compliance related tasks as they arise Qualifications To perform this job… more
- WEL Companies (De Pere, WI)
- …1st Shift Job Category Safety Description POSITION SUMMARY As a Claims Representative, you'll be interacting with WEL departments, drivers, insurance companies, ... information and comments, as well as actions taken. Review claims by approving or disapproving customers claims ....Review claims by approving or disapproving customers claims . Review insurance invoices for accuracy. Investigate when damage… more
- Carrot (Des Moines, IA)
- …Bachelors Degree 1-3 years of relevant work experience including claims submission/processing experience Highly detail-oriented and organized Structured thinker and ... issues An innovative spirit to push the boundaries of claims operations Preferred Qualifications: Literacy in Spanish (to support...to lean in to changing priorities and processes Track claims and denials through the entire lifecycle Identify gaps… more
- buyer (New York, NY)
- …This position will work with our application vendors as well as Claims Operations, Utilization Management, Network Management, and other operational areas to ... performed by delegated vendor as it relates to benefit configuration, claims processing, provider setup and account payable systemManage activities and… more
- buyer (New York, NY)
- …escalated calls by members and providers requiring intervention.Investigates and resolves claims -related issues as needed.Conducts all other duties or actions as ... required under the direction of the MLTC management teamMinimum QualificationsBachelor's Degree required; and2 years of experience in a managed care organization required; additional experience preferredGood communication and interpersonal skills.Understanding… more
- Formation Bio (New York, NY)
- …consistent, and actionable. You'll work across healthcare (EHR, claims , real-world data), commercial/pharma (pricing, formulary, market data), biomedical ... industries. Deep expertise in at least one data domain (eg, healthcare/EHR/ claims , commercial/pharma, biomedical/scientific, or finance), with a track record of… more
- Bond Legal (Irvine, CA)
- …on the clients' behalf when appropriate *Draft, review, and modify claims , motions, discovery responses, demand letters, pleadings, subpoenas, memorandums, and other ... legal documents *Investigate potential personal injury claims and provide legal advice to prospective clients accordingly *Record and update the status of all case… more
- Merck & Co. (Rahway, NJ)
- …and category strategy alignment, sourcing and contracting execution, contract and claims management, project and risk management practices, and supplier relationship ... management, all in alignment with Global Category teams. Role Responsibilities Project Procurement Planning Use your capital procurement expertise to influence global project teams and senior management in developing procurement strategies for large capital… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …marketed products, in order to manage/process patent term extensions, Orange Book listings, claims for regulatory exclusivity, as well as ensure that any new patent ... protections available are obtained for new uses, different results, etc.; counsels development teams for pipeline products on IP, regulatory, and contractual issues arising during the course of product development.- Monitors current developments in several key… more
- Merck & Co. (Rahway, NJ)
- …factual and other issues pertaining to mass tort and commercial litigation claims and work closely with business units to properly defend and/or prosecute ... matters Assist other members of legal team as needed across all business units Perform risk assessments and determine when and how to resolve legal issues with input, as appropriate from key legal and other stakeholders Manage antitrust cases and provide… more
- JobElephant (Las Vegas, NV)
- …or other conference/event attendance, travel arrangements and submission of travel claims for reimbursement.Legal Counsel Support: Assist the General Counsel for ... or other conference/event attendance, travel arrangements and submission of travel claims for reimbursement. Acceptance of Summons/Complaints (Service) on behalf of… more
- Eisai, Inc (Nutley, NJ)
- …Code - Federal Food, Drug, and Cosmetic Act - Anti-Kickback Statute - False Claims Act - OIG/DOJ Guidance - Federal and State Transparency laws - Foreign Corrupt ... Practices Act Proven project management skills with the ability to prioritize and manage multiple initiatives Proficiency in Excel and PowerPoint; experience with Veeva, Concur, and CRM systems strongly preferred Excellent communication skills with the ability… more
