- Eisai, Inc (Nutley, NJ)
- …and validation testing standards for the department, and monitors compliance with these standards.Oversee data quality management process for assigned ... sales and script data (DDD, NSP, Xponent, DataView, longitudinal patient data , claims data , etc.)A minimum of 10 years' experience in the pharmaceutical… more
- Merck & Co. (North Wales, PA)
- …expertise with electronic healthcare databases (electronic medical records and insurance claims ); efficiently manipulates large databases including complex data ... gather and interpret user requirements from epidemiologists, retrieve the required data from electronic healthcare databases, and develop disease cohorts, analytical… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …managing our supply chain and sampling, supporting technological and data innovation, insights and analytics, delivering patient support solutions, maintaining ... Part D, & Managed Care contracts. This role is responsible for ensuring the validation of formulary eligibility for invoicing of all Commercial and Part D rebates as… more
- LA Care Health Plan (Los Angeles, CA)
- Claims Compliance Data Validation Analyst II Job Category: Claims Department: Claims Data and Support Services Location: Los Angeles, CA, US, ... and to support the safety net required to achieve that purpose. Job Summary The Claims Compliance Data Validation Analyst II supports the collection and … more
- LA Care Health Plan (Los Angeles, CA)
- …Degree Experience Required: 1 year of experience in healthcare insurance coordination, claims processing, or data validation . Experience in Customer ... Data Validation - Review and validate coordination of benefits data , including insurance policies, coverage details, and claims information. Identify… more
- MyFlorida (Tallahassee, FL)
- …utilizing a proprietary prize payment software system. + Review and process claims /tickets presented for payment ensuring compliance with established prize ... correctly. + Review and process any state owed debt claims that result from the validation process....and security review as deemed necessary. + Audit paid claims to ensure prizes were paid in compliance… more
- CGI Technologies and Solutions, Inc. (Baltimore, MD)
- …the dispenser, checking for duplicates, checking for 340B status, checking for claims adjustments, and other validation exercises). * Knowledge and experience ... **Drug Claims Processing SME** **Category:** Business Consulting, Strategy and...healthcare market, Medicare Part B and Part D processes, data flows, and pharmacy reimbursement processes. * Collect, analyze,… more
- Alight (MN)
- …Are you a successful leader who is experienced in leading a team of Claims professionals? Do you have experience leading a team that is responsible for providing ... Very High Standards" important to you? If so, Alight is seeking a Claims Operations Manager with experience meeting team service goals and objectives including… more
- Trinity Health (Farmington Hills, MI)
- …of the revenue cycle process for an assigned PBS location. Documents claims billed, paid, settled, and follow-up in appropriate system(s). Identifies and escalates ... objective of maximizing reimbursement for services rendered and ensuring claims are paid or settled in a timely and...payers determining the cause for delay and supplying additional data as required. May prepare special reports as directed… more
- LA Care Health Plan (Los Angeles, CA)
- Financial Compliance Data Manager II Job Category:...Medicare data validation template. Coordinates data validation with the Claims ... required to achieve that purpose. Job Summary The Financial Compliance Data Manager II is responsible for...Group (PPG's) and Specialty Health Plans (SHP) . The data validation template created in visual basic… more
- BeiGene (San Mateo, CA)
- …includes rules to manage key business processes for customer alignment, channel data (3PL/SP/SD/Voucher/Copay), patient journey, patient claims , VA sales & ... partner closely with Sales, Marketing, Market Access, Medical Affairs, Compliance , GTS, Business Planning & GTS organizations. This position... data , Patient Hub data , VA data , CRM, Digital, MCM & Claims is… more
- Veterans Affairs, Veterans Health Administration (Iowa City, IA)
- …of data accessed include health data , demographic data , administrative data , claims data , programmatic data , and patient behavior, provider ... recommendations in support of IT security plans to ensure compliance with Agency security requirements specific to data...and external process or system reviews, studies, projects, and data validation efforts, which provide a mean… more
- J&J Family of Companies (Titusville, NJ)
- …and features, development standards, release management processes and schedules, testing / validation , and compliance . + Lead Analytics Capabilities roadmap in ... limited to Patient Access Services, sales and marketing syndicated data , CRM, digital, lab, hub, claims , specialty...marketing syndicated data , CRM, digital, lab, hub, claims , specialty pharmacy, etc. **Other:** + This position's primary… more
- Alight (IN)
- …Leader in establishing standardized policies and procedures for the administration of insurance claims related to leave absence | Ensure compliance with industry ... and external stakeholders. . Risk Management: | Mitigate risks associated with claims processing errors, fraud, and non- compliance . | Implement preventive… more
- Trinity Health (Farmington Hills, MI)
- …appeal letters to resolve payment rejections and/or denials. + Updates and refiles timely, accurate claims . + Reports and maintains data on types of claims ... resolves payment delays and/or variances resulting from rejected and/or denied claims and/or overpayments and underpayments with direction from the Supervisor… more
- Travelers Insurance Company (Troy, MI)
- …this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim ... resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business… more
- Amgen (Thousand Oaks, CA)
- …(FDA, EU & global standards). + Assist in the development of any existing validation program to ensure continued compliance to the necessary regulations. + ... excellence in aseptic processing, technology transfer, process characterization, process validation and continuous process verification. A focus on visual inspection… more
- Travelers Insurance Company (Centennial, CO)
- …for the handling of the contents portion of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim ... resolution for personal or business property claims of moderate to high severity, ie Major Case Unit losses. Assists in the investigating, scoping and estimating for… more
- Travelers Insurance Company (Silver Spring, MD)
- …supervision, this position is responsible for handling first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal ... claim resolution for personal or business claims of high severity and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts,… more
- HUB International (Chicago, IL)
- …Analytics (IA) platform and other analytics tools, manages, evaluates, decodes claims data across service lines/initiatives (eligibility, medical, pharmacy, ... vast network of experts who will help you reach your goals through risk services, claims management, and compliance support. And this gives you the peace of mind… more
