- CHRISTUS Health (Winona, TX)
- …CHRISTUS services. These services will be provided by monitoring cases and claims , analyzing biometric and health risk assessment data, organizing disease management ... cost analysis and other reports to determine the reasonableness of claim /cost data and utilization rates.Make recommendations based on data analysis for… more
- Neighborhood Health Plan of Rhode Island (Smithfield, RI)
- …Integrity initiatives and projects. This role will act as the point of contact for claim related research. Serves as a claims subject matter expert (SME) and ... Acts as a claims subject matter expert (SME) and resource/support for claim edit and payment policy initiatives Conducts in-depth research on complex claim … 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
- Eisai, Inc (Nutley, NJ)
- …well as managing Eisai's insurance requirements to provide optimum coverage, costs, and claim settlements is falls within the scope of this position.The Manager of ... calculations for premium adjustments; Manage the end-to-end process of claim settlement, including documentation, coordination with insurers, and resolution;… 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
- 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
- Aequor (Golden Valley, MN)
- …The Certifications Specialist is responsible for assuring compliance of third-party claims and certifications. This Certifications Specialist position is a technical ... globally to support business needs. Key Accountabilities: Provide global claims and certification expertise and collaborate cross-functionally to leverage… 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
- Merck & Co. (North Wales, PA)
- …as a deep technical understanding of Life Sciences data sets (eg, claims , electronic health records) and advanced modeling approaches. Using this expertise, this ... orchestration engines.Proven experience with Life Sciences data sets-such as claims data, electronic health records (EHRs), and prescription data.Strong expertise… 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
- 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
- Merck & Co. (Rahway, NJ)
- …analyze data leveraging advanced analytical/statistical techniques from disparate databases/sources ( claims data/EMR Data and other sources) to drive optimization ... deliver measurable impact in commercial pharma landscape.Knowledge in mining medical claims , consumer data with a strategic/inquisitive mindset and proven 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)
- …management Substantive contributions to labeling committees. Ensure labels contain fair-balanced claims supported by data and supportive of asset value proposition ... requirements for most geographies Management Leads, coordinate and assess strategy related to this group Global Medical Team (MT) of Medical Affairs colleagues (including Regional Directors Medical Affairs) assigned to asset(s). Education Minimum Requirement:… more
- Eisai, Inc (Nutley, NJ)
- …research studies. Experience in analyzing and collecting patient-reported outcomes, claims and EMR databases. Demonstrated ability to work collaboratively in ... and lead cross-functional teams.Leadership and people management experience is desirable. Expertise in the design and execution of HEOR studies, including the writing of protocols and analytic plans for prospective and retrospective studies.Application of… more
- Eisai, Inc (Atlanta, GA)
- …(eg, PhRMA Code; Federal Food, Drug, Cosmetic Act; Anti-Kickback Statute; False Claims Act, OIG/DOJ Guidance; Foreign Corrupt Practices Act; and federal and state ... transparency and disclosure laws).Experience networking, establishing, and maintaining strong business relationships across multidisciplinary matrix teams within Eisai.Sr. Area Business Leader- OncologyMinimum 5 years of sales management experience in a… more
- Eisai, Inc (Pittsburgh, PA)
- …(eg, PhRMA Code; Federal Food, Drug, Cosmetic Act; Anti-Kickback Statute; False Claims Act, OIG/DOJ Guidance; Foreign Corrupt Practices Act; and federal and state ... transparency and disclosure laws) preferred.Demonstrated skills at building and maintaining professional relationships with key customers and others in the customer influence network, preferred.Experience in business analytics to understand and analyze… more
- Soliant (Clearwater, FL)
- …fast-paced, team-driven environment. Key Responsibilities: Process prescriptions, handle insurance claims , and resolve rejections Package and label medications for ... pharmacist verification Manage data entry, prescription paperwork, and patient/provider communication Conduct cycle counts, restock inventory, and review expiration dates Assist with returns, quarantines, and medication destruction Support cross-functional… more
- PharmaCord (Jeffersonville, IN)
- …and resources related to local, regional or national payer coverage or claim submission process Clearly articulate complex reimbursement and billing information to ... and regional payer coverage policies, issues, coding changes, and appropriate claims submission processes Educate offices about the medical necessity requirements… more
