- Trustmark (Boston, MA)
- …our colleagues, clients and communities. **About the role** This role is a dedicated training position for Claims that resides in the Knowledge Management & ... of claim handling process and procedures and experience in handling claims appropriately in accordance with the corporate claim philosophy, policy provisions… more
- Deloitte (Boston, MA)
- …who wants to work in a collaborative environment? As an experienced Epic Billing and Claims Senior Analyst you will have the ability to share new ideas and ... configuration and builds by maintaining industry and client standards ensuring build quality and timeline adherence as well as debugging and resolving any… more
- Commonwealth Care Alliance (Boston, MA)
- …Claims Position Summary: Reporting to the Director, Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr . Specialist II is ... CMS Medicare requirements. This role is housed within the Claims Operations & Quality Assurance team and...file sampling, and audit submission timelines. * Assist in training internal staff on audit protocols and documentation standards.… more
- The Hartford (Boston, MA)
- Sr Consultant Risk Engineering - KR08DE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. ... of multi-location accounts. Consultative Selling Skills: Must apply sales training techniques to uncover the business needs of the...submitted in a timely fashion and be of high quality . These reports must provide direction to the insured,… more
- Intermountain Health (Boston, MA)
- …of actual and budgeted contractual allowances and variances, monitoring of individual claims (logs), etc.). Interacts with HIM, PAS, and hospital finance staff as ... hospital personnel as needed. + Acts as a mentor. As assigned, coordinates training , direction and review of those working with reimbursement functions. + Manages… more
- CenterWell (Boston, MA)
- …**Key Responsibilities:** + **Operational Reporting:** Oversee the medical and prescription claims processes, including quality , audits, and reporting. Manage ... community and help us put health first** As a Sr . Business Intelligence Engineer for CenterWell Primary Care, you...operations & BI reporting and a passion for data quality and process improvement. The ideal candidate will have… more
- Prime Therapeutics (Boston, MA)
- …our passion and drives every decision we make. **Job Posting Title** Senior Health Outcomes Researcher - Remote **Job Description** The Health Outcomes Researcher ... focused on drug utilization, combined medical and pharmacy drug claims , with a view to the impact on patient...of Principal Health Outcomes Researcher, Principal Data Scientist, or Sr Dir Health Outcomes, define and document complex study… more
- Cherry Bekaert (Boston, MA)
- **Description** **Summary of Responsibilities:** The Senior Associate will work closely with the Cherry Bekaert FAO (Finance & Accounting Outsourcing) team, ... for our clients in the insurance, service and related industries. The Sr . Associate will also assist in an administrative project management capacity, spearheading… more
- United Therapeutics (Boston, MA)
- …practices, you drive a culture of compliance with confidence and enthusiasm. The Senior Corporate Compliance Manager - Training , Communications and Policy will ... experiences. Detail-oriented yet creative, you balance policy management with innovative training strategies that resonate across all levels of the organization. You… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Senior Encounter Data Management Professional develops business processes to ensure successful submission ... considerable latitude in determining objectives and approaches to assignments. The Senior Encounter Data Management professional ensures data integrity for claims… more
- Atlas (Woburn, MA)
- …at any and every step of the project, and with a heart-led approach that puts quality and safety at the center of everything we do. We're just built to be better. ... Description** Atlas is looking for someone to join our Legal Team as ** Senior Litigation Counsel (Engineering / Construction)** to be located in one of our… more
- Fallon Health (Worcester, MA)
- …Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high- quality , coordinated care and is continually rated among the nation's top ... health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, self-expression, and unique… more
- Walgreens (Worcester, MA)
- …certification/registration. Otherwise, earns PTCB certification as condition of promotion to senior technician. + Attends training and completes PPLs requested ... and procedures in relation to pharmacy errors and the Quality Improvement Program. + Strictly adheres to the Walgreen...those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a… more
- Walgreens (Woburn, MA)
- …to Company policies and procedures in relation to pharmacy errors and the Quality Improvement Program. Strictly adheres to the Walgreen Co. policy regarding Good ... the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and… more
- CenterWell (Boston, MA)
- …of our caring community and help us put health first** The Senior Pharmacy Contracting Professional is responsible for reporting, implementation, and maintenance of ... Humana's Healthy Horizon Medicaid business. The Senior Pharmacy Contracting Professional work assignments involve moderately complex to complex issues where the… more
- Bank of America (Boston, MA)
- Fraud Analytics and Innovation Senior Leader - Client Protection Newark, Delaware;Plano, Texas; Richmond, Virginia; New York, New York; Boston, Massachusetts; ... to align fraud management efforts with organizational goals. Conduct training sessions and workshops to educate staff on fraud...to fraud and claim activity. Validate the integrity and quality of data required for performing analysis. * Partner… more
- WellSense (Boston, MA)
- Senior Provider Relations Consultant, BH Network Strategy WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New ... works for our members, no matter their circumstances. **Job Summary:** **The Senior Provider Relations Consultant (Snr PRC) is responsible for managing an assigned… more
- Fallon Health (Worcester, MA)
- …Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high- quality , coordinated care and is continually rated among the nation's top ... health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, self-expression, and unique… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Senior Financial Reporting Professional/ Analyst prepares and distributes periodic financial statements ... other than those directly employed by the organization. The Senior Finance Reporting Professional/ Analyst + Analyzes and forecasts...all business areas such as: Finance, Network, Health Services, Claims and Actuarial **Use your skills to make an… more
- LogixHealth (Bedford, MA)
- Location: Bedford, MA; Hybrid This Role: The Senior Network Engineer is responsible for configuring, maintaining, monitoring, and securing LogixHealth's global ... Ability to create and maintain documentation for knowledge base articles, team training , procedure and policy documents, network diagrams + Ability to communicate… more