- Robert Half Legal (Farmington Hills, MI)
- …A prominent Michigan-based organization in the insurance sector is looking for a dynamic Claims Director . This position is ideal for an experienced leader with ... expertise in claims management, litigation oversight, and operational strategy. *This is...to ensure accuracy and compliance. + Support the executive director and collaborate with leadership on organizational strategy and… more
- Zurich NA (Detroit, MI)
- Executive Underwriter OR AVP, Underwriting Director - Contract Surety 124610 Zurich North America is currently looking for a Contract Surety Underwriter **to join our ... filled at either the Executive Underwriter OR AVP, Underwriting Director - Contract Surety officer level. The hiring manager will...and 10 or more years of experience in the claims or underwriting support areaOR + Zurich approved Apprenticeship… more
- Molina Healthcare (Detroit, MI)
- **Job Description** **Job Summary** The Network Solutions Director is responsible for leading a team designing and executing new solutions. The position requires the ... lead a diverse team of technical experts and business analysts. The Solutions Director will interface with IT and business leaders to enable enterprise wide… more
- Molina Healthcare (Detroit, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... the development, implementation and maintenance of provider data in the claims payment system. * Supports critical business strategies by providing systematic… more
- Molina Healthcare (Detroit, MI)
- …activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- Corewell Health (Southfield, MI)
- …activities such as personnel file requests, subpoena responses, unemployment claims processing, internet usage reporting, internal review processes, exit interviews, ... team member qualifications including health requirements, regulatory audits, team member investigations, verifications of employment, etc. + From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course… more
- Molina Healthcare (Detroit, MI)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Molina Healthcare (Detroit, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems ... leadership based on feedback rom assigned MHI attorney. * Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting. * Advises… more
- University of Michigan (Ann Arbor, MI)
- …extended personhood or rights? + What is the basis for environmental justice claims ? **Responsibilities + Meet weekly with the instructor + Attend lecture classes + ... serve as a GSI in the course. The Faculty Director or his/her designate will review GSI assignments based...similarly qualified candidates, the faculty member and the Faculty Director should be race and gender inclusive in the… more
- R1 RCM (Detroit, MI)
- …+ Review and apply client contract language and rates to resolve denied claims . + Utilize payer-provider and administrative manuals to dispute denied claims . ... Internal High Balance Meeting Calls for their assigned areas and/or providing to the Director a full report prior to these meetings on the status of accounts… more
- Trinity Health (Farmington Hills, MI)
- …government accounts at an assigned PBS location. Monitors timeliness of claims billed, paid/settled, and reviews documentation in appropriate system(s). Ensures ... resolutions based upon colleague findings; reports findings to the Manager and Director Billing and other PBS leadership. Prepares service level metrics and… more
- RxBenefits (Detroit, MI)
- …Manager also assists with resolving client issues involving performance discrepancies and claims issues. This role will support the Director , Pharmacy Pricing ... cross functional role, the Senior Manager, Pharmacy Pricing will report to the Director , Pharmacy Pricing & Analytics. The Senior Manager, Pharmacy Pricing is a… more
- Integra Partners (Troy, MI)
- …UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director ) with administrative and non-clinical tasks related to processing Utilization ... codes + Verify eligibility and claim history in proprietary claims platform + Verify all necessary documentation has been...external sources + Other duties as assigned by UM Director + Strong organizational skills, ability to adapt quickly… more
- Elevance Health (Dearborn, MI)
- …service as required. + Conduct business in a professional manner. + Troubleshoot claims issues. + Investigate and research to resolve customer complaint problems and ... required licensure activities supervised by the Clinical Manager or Clinical Director . **Preferred Qualifications:** + Experience in settings that include inpatient,… more
- Select Medical (Ypsilanti, MI)
- …the Human Resources department in coordination with the regional Human Resources Director and the corporate Human Resources team, payroll department and recruitment ... and/or compliance purposes. + Processing and maintaining all workers' compensation claims , unemployment requests, FMLA and leaves of absences. + Providing services… more
- Molina Healthcare (Detroit, MI)
- …medical management, network contracting and provider relations, member services, claims management, payment integrity, pharmacy, quality and risk adjustment. * ... practice experience, and at least 2 years as a medical director in managed care organization supporting utilization management/quality program management, or… more
- Henry Ford Health System (Detroit, MI)
- …analysis, and prevention of events which may injure patients, lead to malpractice claims , and cause loss to the health care system. The QRS II collaborates ... leads root cause analysis (RCA) investigative team; in collaboration with director , prepares RCA for presentation to leadership. + Facilitates or co-facilitates… more
- Danaher Corporation (Detroit, MI)
- …engagement and responding to customer inquiries. This position reports to the Senior Director Market Access Americas and is part of the Value and Access team. ... coding and reimbursement. + Support customers with approved resources for denied claims , payer coverage expansion and inadequate reimbursement. + Respond to and… more
- AmeriHealth Caritas (Detroit, MI)
- …authorizations, including home- and community-based programs. + Collaborate with the Medical Director and care team to develop and monitor treatment plans. + Address ... service issues and assist with provider or claims -related problem-solving. + May oversee tasks assigned to other licensed or unlicensed professionals involved in… more