- Humana (Juneau, AK)
- …Typically reports to Lead depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- Humana (Raleigh, NC)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- Guthrie (Cortland, NY)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. + Serves ... than one year of experience) Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie...requirements and to assist in ensuring generation of clean claims in a timely manner + Securing authorization as… more
- Guthrie (Sayre, PA)
- …Leads any payer specific external claim audit activity, worked in combination with Management , Compliance, Medical Records and Clinical Operations. 9. Serves as ... Insurance Billing Specialists I and related support staff. Works closely with Director , Manager, Supervisor and Application Analyst on day to day priorities and… more
- Fluor (Greenville, SC)
- …and the Intelligence Community. **Job Description** This position assists in the management and execution of the Prime Contract in conjunction with the Project ... Director and Law Department. Complexity of projects and the...integrated with the project core team. Undertake Prime Contract management execution activities in accordance with the Prime Contract… more
- Crowley Maritime Corporation (Jacksonville, FL)
- …**Job:** **Risk Management * **Organization:** **Risk US 9100* **Title:** * Director , Enterprise Claims Management * **Location:** *FL-JACKSONVILLE* ... insights and influence senior leadership on risk mitigation and emerging trends. . * Claims Management * o Oversee self-administered Hull & Machinery (H&M) and… more
- Walmart (Bentonville, AR)
- …department. This leader will drive innovation, process improvement, and best-in-class claims management , ensuring alignment with industry best practices and ... **Position Summary ** The Senior Director , Walmart Claims Services Strategy and...(WCS) is dedicated to delivering efficient, accurate, and customer-focused claims management across enterprise. The organization is… more
- Ryder System (Cheyenne, WY)
- …clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **Summary** The Director Claims directs activities within the General and ... Auto Liability Claims , Physical Damage Repairs and Property and Cargo Claims including the management of loss control activities and third-party provider… more
- AIG (Jersey City, NJ)
- Claims Complex Director - Healthcare Professional... portfolio of the most complex and high exposure medical malpractice (and some GL) claims at ... Liability (HPL) Join us as a Claims Complex Director to take on key...+ Keeps abreast of significant changes in the law, claims and industry trends (not limited to medical… more
- USAA (San Antonio, TX)
- …of what truly makes us special and impactful. **The Opportunity** As a dedicated Director , Claims Operations, you will manage and be accountable for property, ... for delivering business results. Responsible for leading execution change management , claims strategies, leader development and technology...+ 4 years Property Field Leadership experience at a Director level or Field Claims Manager level.… more
- Centene Corporation (Richmond, VA)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... enhancing data accuracy, and driving efficiency to support timely and compliant claims outcomes. + Leads utilization management team on performance, improvement,… more
- Elevance Health (Atlanta, GA)
- ** Director II, Digital Claims Operations (Dir II Digital Ops)** Location: This role requires associates to be in-office **3 days per week** , fostering ... considered if candidate resides within a commutable distance from an office._ The ** Director II, Digital Claims Operations** oversees a combined digital and… more
- CVS Health (Hartford, CT)
- …it all with heart, each and every day. **Position Summary:** The Lead Director of Software Engineering is responsible for leading engineering teams that support the ... modernization of legacy systems-primarily IBM Mainframe platforms-used for commercial claims routing, adjudication, and operational reporting. This role ensures the… more
- Magellan Health Services (Albuquerque, NM)
- …needs to be licensed in the State where they reside. Maintains accountability for medical management functions to achieve the business and clinical outcomes for ... utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims payment policies and… more
- Aspen Dental (Springfield, IL)
- …proper handling of all claims . Under the general direction of the Director of Risk Management , the Manager is responsible for mitigating, reporting, and ... as a **Risk Management , Claims Manager.** **Job Summary:** The Risk Management Claims Manager will manage the administration of claims for incidents… more
- UNC Health Care (Chapel Hill, NC)
- …health and well-being of the unique communities we serve. **Summary** : Reporting to the Director of Claims & Litigation, the Claims and Litigation Manager ... self-insurance liability programs. This position handles internal investigation process of claims , including analysis of medical records, interviews with… more
- State of Colorado (Denver, CO)
- …to include: Claims adjusting related work and duties, workers compensation claims management to include form completion and submission, calculating benefit ... as other related claims duties assigned. The Claims Managers assist claimants, attorneys, medical providers,...process may request a review by the State Personnel Director . As an applicant directly affected by the results… more
- University of Miami (Miami, FL)
- …and documentation of potentially compensable events to Chief Medical Risk Officer, Director of Medical Claims and Assistant General Counsel. + Conduct ... reportable events and prepare submission for approval by Associate Medical Risk management Officer and the Chief...and physicians in sensitive situations involving actual or potential claims . + Analyze and trend data as captured through… more
- US Tech Solutions (Whittier, CA)
- …will be indicated by a high school diploma or equivalent; four years medical claims processing. **Preferred:** *Department Management to list. **DUTIES ... educational and environmental needs of patient/significant other when administering care. 4.Assist the Claims Director in the training and education of the … more
- Commonwealth Care Alliance (Boston, MA)
- …under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible ... Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for...and Analytics + Direct and relevant experience with HCFA/UB-04 claims management , coding rules and guidelines, and… more