- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Claims Review Representative 3 makes appropriate claim decision based on ... procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3...and state and federal legislation. The Claims Review Representative 3 performs advanced… more
- Highmark Health (Boston, MA)
- …position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist distribution. Interpret ... added benefits. Meet with all identified practices in assigned territory to review practice financial and quality performance. + Perform effective on-site visits… more
- Commonwealth Care Alliance (Boston, MA)
- …is a subject matter expert in the area of medical policy development and review and works collaboratively with the Sr. Medical Director of Medical Poliy and other ... Coordinate with the Knowledge Hub Team on the annual review of all existing Medical Policies. + Manage the...prior authorization program. + Support the payment policy and claims teams in the development of payment policies, and… more
- Prime Therapeutics (Boston, MA)
- …partnerships with various levels of leadership within the organization, acting as a representative of the broader Reporting and Analytics team + Coach and provide ... of work experience in data analysis and reporting + 3 years of SQL experience + Must be eligible...experience + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data… more
- LogixHealth (Bedford, MA)
- …internal and external client communications are responded to in a timely manner 3 . Maintain/ensure all client information in CRM coding fields, Master Client Grid, ... up to date by following Coding Policy QA process 4. Execute the Annual Coding Policy Review project/push out all policies to clients for a review and to follow… more
- Weston & Sampson (Worcester, MA)
- Weston & Sampson is seeking a Senior Resident Project Representative or Senior Construction Inspector for oversight and inspection of utility and infrastructure ... as part of a team of professional engineers. What you'll do: + Review of contract documents and construction management requirements to identify and report degree… more