- Commonwealth Care Alliance (Boston, MA)
- …Alliance's (CCA) diverse provider community - including physician, hospital, behavioral health , community-based, LTSS, and HCBS providers. This individual serves as ... relationships with providers across all specialties -, physician, hospital, behavioral health , community based, and ancillary providers and their staff. + Serve… more
- NJM Insurance (NJ)
- …growth and success of our policyholders' business operations. To meet these expectations, WC Claims Specialists are supported by a dedicated call center who can ... and agents in that area. This is a 100% remote position which includes virtual claims handling...employer match up to 8% and additional service-based contributions, Health , Dental, and Vision insurance, Life and Disability coverage,… more
- CenterWell (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Manager of Pre-Bill Audit provides strategic leadership and operational oversight for the ... organization's pre-billing function. This role is responsible for ensuring all claims are audit-ready prior to release, driving standardization across branches, and… more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... well as a focus on collaborative business relationships, value-based care, population health , or disease or care management. Medical Directors support Humana values… more
- Humana (Juneau, AK)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... as well as a focus on collaborative business relationships, value based care, population health , or disease or care management. **Use your skills to make an impact**… more
- CVS Health (Hartford, CT)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...**Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as… more
- Centene Corporation (Indianapolis, IN)
- …implementation of recommendations to providers that would improve utilization and health care quality. + Reviews claims involving complex, controversial, ... 28 million members as a clinical professional on our Medical Management/ Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Jefferson City, MO)
- …implementation of recommendations to providers that would improve utilization and health care quality. + Reviews claims involving complex, controversial, ... 28 million members as a clinical professional on our Medical Management/ Health Services team. Centene is a diversified, national organization offering competitive… more
- CareFirst (Baltimore, MD)
- …the Risk Adjustment Coding guidelines, as well as, guiding junior coding specialists are included in the job responsibilities. **ESSENTIAL FUNCTIONS:** + Verifies ... changes in industry standards. + Provide guidance and direction to Coding Specialists when reviewing complex medical records to help guide in determining appropriate… more
- The Cigna Group (Newburyport, MA)
- …insurance, and payment information. + _Be a team player_ - Escalate complex claims to the Sr. Billing & Reimbursement Specialists for appropriate action. ... of benefits, with a focus on supporting your whole health . Starting on day one of your employment, you'll...day one of your employment, you'll be offered several health -related benefits including medical, vision, dental, and well-being and… more
- The Hershey Company (IN)
- …and off-site medical providers, including, but not limited to, physical therapists, specialists , and/or Nurse Case Managers. * / Claims Management/* * Timely ... *Whitestown, Indiana - Onsite, 5 days per week (No Remote ) * Job Summary:* Reporting to the EHS manager,...Job Summary:* Reporting to the EHS manager, the Occupational Health Nurse will provide professional and comprehensive health… more
- CommonSpirit Health (Phoenix, AZ)
- …Advantage, Medicaid, and commercial payer programs. Oversee integration of clinical and claims data to support whole-person care. Population Health & Managed ... **Job Summary and Responsibilities** The System Director of IT Population Health Services Organization (PHSO) is a leader responsible for the strategic oversight,… more
- University of Rochester (Albany, NY)
- …to all and is a place where all can thrive. **Job Location (Full Address):** Remote Work - New York, Albany, New York, United States of America, 12224 **Opening:** ... of the individual, and internal equity considerations._ **Responsibilities:** The Claims Resolution Representative III is responsible for working across the… more
- Virtua Health (Moorestown, NJ)
- At Virtua Health , we exist for one reason - to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to ... care you need. Whether that's wellness and prevention, experienced specialists , life-changing care, or something in-between - we are...or something in-between - we are your partner in health devoted to building a healthier community. If you… more
- Otsuka America Pharmaceutical Inc. (Harrisburg, PA)
- …diseases + Ensure MSLs effectively interact with multidisciplinary care teams of specialists (eg, metabolic specialists for PKU, neuromuscular specialists ... specialized therapeutic area with complex patient journeys and limited physician specialists + Proven success in developing and executing national medical… more
- Centene Corporation (Jefferson City, MO)
- …implementation of recommendations to providers that would improve utilization and health care quality. + Review claims involving complex, controversial, ... 28 million members as a clinical professional on our Medical Management/ Health Services team. Centene is a diversified, national organization offering competitive… more
- Otsuka America Pharmaceutical Inc. (Jefferson City, MO)
- …+ **Team Management** : Lead a high-performing team of operational specialists , including webinar production, medical writing, and customer service engagement ... specialists . + **Data-Driven Insights** : Utilize data analytics and...thinker with a results-oriented mindset. + Experience working in remote or hybrid teams is a plus **Competencies** **Accountability… more
- Abbott (Livermore, CA)
- …large enterprise. + Prior experience with SOX, PCI, and HIPAA compliance + **Insurance claims / Health Care Industry experience** **Misc: This role is based at our ... career you dream of. + Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year + An excellent… more
- Otsuka America Pharmaceutical Inc. (Rockford, IL)
- …the corporate philosophy: "Otsuka-people creating new products for better health worldwide." Otsuka researches, develops, manufactures and markets innovative ... unmet medical needs and nutraceutical products for the maintenance of everyday health . In its evolved customer engagement model, a Neuroscience Specialist engages… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …of Minnesota Position Title: Care Advocacy Case Manager RN - Bilingual Spanish Location: Remote Career Area: Health Services About Blue Cross and Blue Shield of ... benefits; eg Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health Management Division....of Work Remote Requisition ID 2934 Job Type Full Time Job Benefits Health Insurance Application Link… more
