- Lincoln Financial Group (Columbus, OH)
- …Provides subject matter expertise and technical guidance to claim team members on claims adjudication . + Reviews and resolves complex escalated issues and ... ensure the fair, ethical and timely management of complex claims . **What you'll be doing** + Maintains knowledge on...million customers trust our guidance and solutions across four core businesses - annuities, life insurance, group protection and… more
- The Cigna Group (Morris Plains, NJ)
- …to head an adjudication team that supports all aspects of our core adjudication platform along with managing Client Intent capabilities, Consumer Driven ... Health and other key areas directly related to supporting our core Adjudication platform. Working closely with Business, Operations, and Technology partners… more
- LA Care Health Plan (Los Angeles, CA)
- …to ensure the Plan's core system produces a high level of claims auto adjudication . Develops policies and guidelines that ensure work activities are ... Manager, Claims Job Category: Claims Department: ...highest quality and is well documented. Works with the Claims Director , Claims Managers and… more
- Mitsubishi Chemical Group (Jersey City, NJ)
- …from diverse internal and external sources (eg, digital platforms, prescription claims data, specialty pharmacy adjudication , patient support activity, market ... but not limited to audience engagement metrics from digital platforms, prescription claims data, specialty pharmacy adjudication data, patient support activity… more
- Rising Medical Solutions (Chicago, IL)
- As our Director of Specialty Bill Review Services, you will maximize savings and client satisfaction by providing strategic direction for Rising's Specialty Services ... unit involving complex/large medical claims ; analyzing and optimizing bill review procedures and systems;...with other members of Rising's management team to support core values and achieve company objectives. + Monitor changes… more
- Blue KC (KS)
- **Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some ... customer resource for interpretation of transplant benefits and transplant-related claim adjudication . Serves as a company expert on current and future transplant… more
- Fallon Health (Worcester, MA)
- … claims functions through authorization adjustment guidelines to assist with adjudication of claims provided for missing information. + Special projects/other ... action planning must be established for each respective case and adjudication completed in accordance with existing regulations, policies, and standards.… more
- CVS Health (Buffalo Grove, IL)
- …This position works closely with other technical leaders of the myPBM space & Claims Adjudication team to assess business goals, strategic objectives and to ... more personal, convenient and affordable. Job Purpose and Summary: The Lead Director , myPBM is responsible for managing the technical needs across non-clinical myPBM… more
- CVS Health (Buffalo Grove, IL)
- …This position works closely with other technical leaders of the PBM space & Claims Adjudication team to assess business goals, strategic objectives and to build ... care more personal, convenient and affordable. Job Purpose and Summary: The Lead Director , PBM Benefits is responsible for managing the PBM Benefits space in the… more