- Sedgwick (Fort Worth, TX)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Director Complex Claims **PRIMARY PURPOSE** **:** To be responsible for managing ... Bachelor's degree from an accredited college or university preferred. Fraud Claims Law Associate (FCLA), Certified Insurance Fraud Investigator (CIFI), or Certified… more
- Humana (Honolulu, HI)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to...>65 years of age). + Current and ongoing Board Certification an approved ABMS Medical Specialty + A current… more
- Integra Partners (Troy, MI)
- … processing adheres to HIPAA regulations and payer-specific guidelines. + Document claim activity and payer communications in the claims management system. ... Integra is seeking a results-oriented, dynamic, proven Claims Examiner, with a specific background in the...billing with our payers, and both our Network and Claim 's teams. The ideal candidate thrives by collaborating with… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims ... to have the one or all of the required certification OR willing to get certified within 1 year...claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic… more
- HCA Healthcare (Nashville, TN)
- …in territory assigned. + Oversight and administration of special projects as assigned by the Claims Director , HCI President and VP of Claims . + Have strong ... Claims Department and in the larger Risk & Insurance Department reporting to a Director of Claims . The Senior Claims Supervisor is responsible for… more
- Community Health Systems (Franklin, TN)
- …and internal staff. + Effective communication and negotiation skills for complex claim resolution. + Proficiency in claims management software and Microsoft ... **Job Summary** The Manager, Medical Malpractice and General Liability Claims is responsible for overseeing professional and general liability claims , including… more
- WFF Facility Services (Knoxville, TN)
- Workers Compensation Claims & Risk Manager (300) (HR) Knoxville, TN, United States of America $90,000.00 - $110,000.00 Back Apply Now Back Apply Now Overview HES is ... any other characteristic protected by law. Job Skills / Requirements The Claims Manager is responsible for investigation and oversight of all workers compensation,… more
- Metropolitan Council (St. Paul, MN)
- …of loss. It also self-administers all auto liability, general liability, and workers' compensation claims . We are hiring a Director of Risk Management to develop ... Director - Risk Management Print (https://www.governmentjobs.com/careers/metrocouncil/jobs/newprint/4822122) Apply Director - Risk Management Salary… more
- Covenant Health (Bangor, ME)
- Job Summary The Director of Risk Management and Compliance is accountable and responsible for the management and direction of the risk management and loss prevention ... identify, monitor, and report on risk trends. + Oversee claims management for cases at St. Joseph Hospital-Bangor and...operations for St. Joseph Hospital-Bangor. Ensure timely investigations and claim reports by the TPA. Monitor case activity of… more
- American Medical Association (Chicago, IL)
- Director II, HS Program Chicago, IL (Hybrid) The American Medical Association (AMA) is the nation's largest professional Association of physicians and a non-profit ... know you. We have an opportunity at our corporate offices in Chicago for a Director II, HS Program on our Health Solutions team. This is a hybrid position reporting… more
- State of Massachusetts (Quincy, MA)
- …HSN Operations unit which includes overseeing Safety Net help desk, manual claims payments, Medical Hardship application and payments, claim waiver requests ... Medicaid (or MassHealth) under the Executive Office of Health and Human Service. The Director of Safety Net Programs oversees the Health Safety Net (HSN) as well as… more
- The County of Los Angeles (Los Angeles, CA)
- DIRECTOR , DISTRICT ENVIRONMENTAL SERVICES Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4809278) Apply DIRECTOR , DISTRICT ENVIRONMENTAL ... various health districts/regions throughout the County. This position reports to the director of environmental health services in the Department of Public Health.… more
- City of New York (New York, NY)
- …projects using complex SQL algorithms and EDW data, analyzing data to identify claims that can be reclaimed for higher federal and state reimbursement rates, ... preparing claim adjustments to maximize federal and state funding, providing...providing technical support, financial analysis, data retrieval and financial claims support to DSS and other City agencies, responsible… more
- CVS Health (Springfield, IL)
- …the Medical Director include support of the appeal process, clinical claim review process, pre- certification , and predetermination of covered benefits in the ... Health company has an outstanding opportunity for a Medical Director . Ready to take your career to the next...Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but… more
- Project Renewal, Inc. (New York, NY)
- 59th Street Women's Shelter - Assistant Director Shelter- 59th Street Women's Shelter, 537 W 59th Street, New York, New York, United States of America Req #1480 ... Wednesday, April 9, 2025 Title: Assistant Director Program: 59 thStreet Women's Shelter Salary Range: $75,000-80,000 annually Program Overview: The 59thStreet… more
- Veterans Affairs, Veterans Health Administration (Amarillo, TX)
- …System, Amarillo, Texas is seeking a Home Base Primary Care (HBPC Medical Director -Physician) within the Geriatric and Extended Care (GEC) Service. The HBPC Medical ... Director will provide clinical care within the GEC service...core specialty training program leading to eligibility for board certification . (NOTE: VA physicians involved in academic training programs… more
- Intermountain Health (Las Vegas, NV)
- …management, claims , network management, and finance. As the Medical Director for Utilization Management, you are responsible, in partnership with MG Clinical ... Medicare coverage criteria. **Job Profile:** **This position is the primary for claims , and claims knowledge and experience including demonstrated experience… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …& Board Certification requirements. Reports adverse changes in licensure, Board Certification to the Senior Medical Director within one business day of ... + This role reports to this job: SENIOR MEDICAL DIRECTOR (MGR) + Necessary Contacts: department Managers, Authorization, Utilization...licensure for the state of Louisiana required + Board certification in a specialty recognized by ABMS required +… more
- Dart Container (Mason, MI)
- Risk Management Director Apply now " Date: May 7, 2025 Location: Mason, MI, US Company: Dart Container We have an opening for a Risk Management Director . This ... study + Requires one of the following: + Advanced certification in Risk Management (eg CRM, ARM, CPCU, or...lines of property, casualty and workers' compensation programs, and claims management to include setting and executing strategy +… more
- Montana State University (Bozeman, MT)
- …position, please contact: Whitney Milhoan ### ###@montana.edu Classification Title Managing Director Working Title Associate Director Medical Services Brief ... specify Recruitment Type Open Position Details General Statement The Associate Director , Medical Services is responsible for assuring the provision of… more