- Commonwealth Care Alliance (Boston, MA)
- …team. Cross-Functional Collaboration - Work closely with network contracting, credentialing, claims , IT, customer service , compliance, and quality teams to ... 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider… more
- CSL Behring (Waltham, MA)
- We are currently recruiting for an experienced, dynamic and visionary Senior Director of Cardiovascular & Renal Global Commercial Development to join our team. This ... driving early product strategy, Target Product Profiles (TPPs), Target Product Claims (TPCs), Stage-Gate Preparation, and Life Cycle Management (LCM) Planning and… more
- Commonwealth Care Alliance (Boston, MA)
- …evaluates efficiency and productivity of utilization management functions for physical health services and long term services and supports. Works closely with ... management functions with network strategy, vendor relationship management and claims processing. Works closely with provider relations on resolving provider… more
- Commonwealth Care Alliance (Boston, MA)
- …+ **Operational Excellence:** + Collaborate with cross-functional teams (eg, Claims , Credentialing, Clinical Care Management, Member Services , Provider ... + Coordinate with other CCA departments, including Clinical Management, Member Services , Claims , Regulatory Affairs, Outreach and Marketing, to resolve… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary** The Program Manager, in collaboration with the Sr Director of Delegation Partnerships and Performance, is responsible for advancing provider ... into other CCA contracts, health equity, Culturally and Linguistically Appropriate Services , Consumer Assessment of Healthcare Providers and Systems (CAHPS), and… more
- Commonwealth Care Alliance (Boston, MA)
- …compliance. The Senior Business Analyst, Clinical Operations reports to the Director , Clinical Operations Support. This role will provide significant BA support ... as, authorizations, assessments, procurement, etc. + Tracks, analyzes and resolves claims issues related to prior authorizations. **Process Improvement** + Partners… more
- Boston Mutual Life Insurance (Canton, MA)
- …courteous. + Leave our customers and associates "better than where we found them." The Director - Claim Services plays a pivotal role within Boston Mutual, ... for managing and overseeing of all aspects of the Claims Service team for Life and Accident...policies. + Stay informed about changes in regulations affecting Claim services . + Develop and implement risk… more
- Sedgwick (Boston, MA)
- …Fortune Best Workplaces in Financial Services & Insurance Business Development Director - Casualty Claims (Northeast Region) As a Business Development ... rapidly growing, industry-leading global company known for its excellence and customer service . + Leverage Sedgwick's broad, global network of experts to both learn… more
- Humana (Boston, MA)
- …outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or ... **Use your skills to make an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Zurich NA (Boston, MA)
- Professional Liability Claims (Attorney), Claims Construction, (Senior or AVP level) 128423 **Zurich North America is expanding its nationwide Construction ... Professional Liability Claims Team with the addition of a dedicated ...expertise and strategic coordination. + Accurately update and document claim files in accordance with best practices, ensuring data… more
- HUB International (Wilmington, MA)
- …: + Provides advocacy for small, middle market, and high-profile clients by reporting claims . + Participate in the claim after hours program as part of ... in-house resource and communicates proactively with clients, production and service staff, claims team and management. +...mentor team associates and training as assigned by Manager/ Director + Attend claim reviews/ meetings with… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims ... claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic and policies… more
- Commonwealth Care Alliance (Boston, MA)
- …states will not be considered at this time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr. ... the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible… more
- State of Massachusetts (Boston, MA)
- …or other mission-based organizations * Experience interacting directly with individuals seeking services or assistance * Experience in claims processing and/or ... the Commonwealth are supported and empowered through access to high-quality services that are trauma-informed, culturally responsive, and reflective of diverse… more
- Evolent (Boston, MA)
- …health outcomes and a more connected care journey. We are hiring for a Managing Director , Actuarial Services to join our Finance Team. The candidate selected for ... to ensure clean and consistent tracking of Evolent's covered membership and claims + Synthesize complex analyses into succinct presentations for communication to key… more
- Sedgwick (Boston, MA)
- …Companies Certified as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Client Services Director **PRIMARY PURPOSE** : To ... determine account management strategies related to managed care client service plans; to be responsible for retention of existing...and to oversee the work of other local Client Services staff. **ARE YOU AN IDEAL CANDIDATE?** We are… more
- Dana-Farber Cancer Institute (Boston, MA)
- … to support and grow the Institute's research, clinical, and business missions. The Director of AI Operations and Services leads the development and delivery of ... solutions that support research, clinical, and operational goals. The Director serves as a subject matter expert in AI...a $3-5M budget and oversee AI and data-science core services , including service level agreements with Informatics… more
- Travelers Insurance Company (Boston, MA)
- …needed to the Claim Field organization. + Provide input into to claim practices, marketing strategy and customer services as appropriate to anticipate, ... Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is… more
- CenterWell (Boston, MA)
- … Director , Primary Care relies on medical background and reviews health claims . The Medical Director , Primary Care work assignments involve moderately complex ... The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex… more
- Commonwealth Care Alliance (Boston, MA)
- …team. Cross-Functional Collaboration * Work closely with network contracting, credentialing, claims , IT, customer service , compliance, and quality teams to ... 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider… more
