- 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
- Humana (Providence, RI)
- …and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs ... of decisions to internal associates, and possible participation in care management. May occasionally participate in discussions with external physicians… more
- Evolent (Providence, RI)
- …a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to ... a mission with a company behind it. **What You'll Be Doing:** ** Associate Director, Performance Analytics - Oncology & Member Product Focus** **Overview:** Evolent… 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
- 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
- Walgreens (Woonsocket, 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
- Walmart (Worcester, MA)
- **Position Summary ** **Are you currently a Walmart associate ?** Please login to your Workday account and use the Find Jobs report to apply for this job. + Find Jobs ... buildings and food safety audits Creates audit reports Acts as an associate interface for workers compensation issues Obtain necessary records Analyzes and reports… more
- Commonwealth Care Alliance (Worcester, MA)
- 023430 Clin Alli-Clin Assessment & CP **Position Summary:** Commonwealth Care Alliance's (CCA) Assessment unit conducts initial and ongoing face-to-face assessments ... and unmet needs. This individual works collaboratively with other members of the care team and staff in other departments as needed to support timely interventions… more
- Humana (Providence, RI)
- …community and help us put health first** Design and maintain Medicaid claims analytics dataset using Databricks. Conduct in-depth analysis of healthcare claims ... Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. Maintain dashboards to communicate key trends to stakeholders. The… more
- Walmart (Putnam, CT)
- …facility level training and execution of asset protection safety functions and claims and receiving procedures by reviewing the application of policies procedures ... training needs and developing and delivering the training where needed Manages claims and receiving operations by ensuring proper policies and procedures are… more
- CVS Health (Woonsocket, RI)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... will perform extensive testing and documentation to ensure accurate prescription claims processing while remaining in compliance with pharmacy standards and payer… more
- Humana (Providence, RI)
- …looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and ... provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters… more
- MAPFRE Insurance (Webster, MA)
- …to reduce cycle time and improve accuracy. + Collaborate with IT and Claims Innovation teams to implement digital tools and integrations with salvage platforms and ... partners. + Resolve escalated customer issues and regulatory inquiries with urgency and care . **Talent Development & Leadership** + Lead and develop a team of… more
- Fallon Health (Worcester, MA)
- …a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon ... Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top...to facilitate the member's medical services or the providers' claims . Interprets and triages information to ensure appropriate action… more
- Humana (Providence, RI)
- …achieving operational and compliance key performance indicators. In addition, the associate will participate in cross functional teams and support analyzing business ... an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and… more
- MAPFRE Insurance (Webster, MA)
- …technology, and business strategy? Join us as a Business Intelligence Analyst ( Claims ) and help shape the future of data-driven decision-making!** **Why You'll Love ... Citizen or Green Card holder + Must have Insuance Claims experience **What You'll Do** + Build and maintain...Business Administration. + 2-4 years of relevant experience (or Associate 's degree plus 4-6 years). + Strong skills in… more
- CVS Health (Woonsocket, RI)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... recommend solutions. **Required Qualifications** + 1 plus years knowledge of plan documents, claims research, letter writing. + 1 plus years working with appeals, … more
- Humana (Providence, RI)
- …have expertise in conducting retrospective observational studies using administrative claims data using a collaborative approach across multiple stakeholders. Humana ... + An understanding of research methodology and the managed care arena, and how it applies to health outcomes...with cloud base analytics platforms + Experience with clinical, claims , pharmacy or other healthcare data. + Strategic thinking… more
- Humana (Providence, RI)
- …of the Pharmacy Analytics division, with responsibilities that include working with pharmacy claims data. The team to which this position reports is dedicated to ... PowerBI + Experience in Databricks is preferred + Experience in analyzing pharmacy claims data Travel: While this is a remote position, occasional travel to Humana's… more
- Humana (Providence, RI)
- …complete and accurate. + Certified Professional Coder or coding knowledge. + Claims knowledge and understanding of claims processing. **Additional Information** ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more