- Lincoln Financial (Pierre, SD)
- …**Requisition #:** 74647 **The Role at a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence team supporting ... coaching and development to perform in this fast-paced environment. As a Claims Customer Care Associate , you will be responsible for answering claimants… more
- Otsuka America Pharmaceutical Inc. (Pierre, SD)
- …Otsuka Precision Health is a health experience company that brings personalized care within reach through products and services for mental and physical well-being. ... **About This Role** We are seeking a strategic, entrepreneurial Associate Director to drive the evolution of OPH's connected...solutions that enhance peoples' lives, we also work to care for our teammates' professional and personal growth and… more
- Intermountain Health (Pierre, SD)
- **Job Description:** Responsible for the timely follow-up of claims billed and resolution of accounts. Oversees the account receivables and maintains ... detailed/accurate account documentation. Follow up on open claims thoroughly, accurately, promptly, and with all supporting documentation. Responsible for… more
- Travelers Insurance Company (Pierre, SD)
- **Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our ... Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to… more
- Highmark Health (Pierre, SD)
- …- from building cost transparency and coverage capabilities, streamlining our billing and claims experience, to helping members afford and pay for care . This ... job will provide support for the development of financial experience portfolio's fundamental value proposition, vision, and execution plans. Working with the Product Manager, this position will analyze customer pain points to determine problems to solve,… more
- Humana (Pierre, SD)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Otsuka America Pharmaceutical Inc. (Pierre, SD)
- …Specialty Medicine products at different stages of development for a global health- care market. The specific duties assigned to the Director, Global Clinical ... research experience (as a general guideline, 1-3 years for Associate Director level; 3-6 years for Director and 6-9...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Humana (Pierre, SD)
- …this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus ... and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and… more
- Humana (Pierre, SD)
- …to assignments. The Senior Encounter Data Management professional ensures data integrity for claims errors that result from the data exchange between Humana and its ... to make an impact** **Required Qualifications** **5 years of medical claims processing/auditing or encounter data management experience** **Demonstrated deep dive… more
- Humana (Pierre, SD)
- …responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Humana (Pierre, SD)
- …external vendors to support quality measure improvement activities. + Investigates claims and medical records to identify opportunities for quality improvement and ... + One (1) year of working in a health care environment/managed care setting. + Proficiency in...skills combined with an understanding of medical record and claims documentation requirements. **Preferred Qualifications** + Master's Degree. +… more
- Humana (Pierre, SD)
- …is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, ... network relationships with large national providers. Ensure adequate coverage of primary care , specialty and ancillary services for Humana to meet both regulatory… more
- Avera (Pierre, SD)
- …advocate will communicate with patients, families, case managers, and providers to assess care plans and corresponding coverage needs and work in a compassionate and ... to help facilitate access to and provide continuity of care . Advocates also work with other members of the...of patient billing issues which may include appealing denied claims . . Work in collaboration with the patient, insurance,… more
- Humana (Pierre, SD)
- …populations served in target growth markets. Candidates will possess Medicaid managed care operations expertise and have experience in designing solutions for key ... member, products and benefits, and health plan administration portfolios (provider, claims , etc.), with areas of focus including Enrollment, Member Experience,… more
- Humana (Pierre, SD)
- …5 or more years' experience working in a Compliance-related or managed care -related field or pharmacy + Experience working with regulatory agencies + Knowledgeable ... improvement and metrics development + Knowledgeable in regulations governing health care industries + Strong communication skills + Experience with pharmacy… more
- Humana (Pierre, SD)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of ... + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate… more