- APTIM (Santa Fe, NM)
- **Job Overview:** The Team Lead -- Claims Review is responsible for supervising a multidisciplinary team of claims reviewers, estimators, and ... + Provide coaching, feedback, and refresher training to ensure team proficiency in claims systems and regulations + Coordinate with SMEs, site inspectors,… more
- Humana (Santa Fe, NM)
- …a part of our caring community and help us put health first** The Supervisor, Claims Review makes appropriate claim decision based on strong knowledge of ... contract provisions, and state and federal legislation. The Supervisor, Claims Review works within thorough, prescribed guidelines...with at least 1 year in a supervisory or team lead role. **Knowledge & Skills:** +… more
- Sedgwick (Santa Fe, NM)
- …a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance (Remote) Claims Team Lead - Workers Compensation | AZ, CO, UT ... management reports and takes appropriate action. + Performs quality review on claims in compliance with audit...Excellent negotiation skills + Ability to work in a team environment + Ability to meet or exceed Performance… more
- Prime Therapeutics (Santa Fe, NM)
- …fuels our passion and drives every decision we make. **Job Posting Title** Lead Claims Processor, Government Programs **Job Description** Adjudicate or submit ... claims and adjustments as required. Track and trend performance...and administrative duties as required by business need. + Lead and implement positive changes with a high level… more
- Humana (Santa Fe, NM)
- …this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all ... some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, and Humana colleagues. After completion of mentored… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- **Senior Director, Early Development Team Lead ** **Role Summary:** The Early Development Team (EDT) Lead is a critical role - working to deliver Otsuka's ... and bring differentiated medicines to patients. The EDT Leader will lead asset focused multi-disciplinary teams from pre-clinical through demonstration of clinical… more
- Molina Healthcare (Santa Fe, NM)
- …work assignment, prioritization, issue triage etc. * Researches complex issues * Acts as a team lead , assigning and prioritizing work for other team members ... Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data… more
- Meta (Santa Fe, NM)
- …Acting as a key partner to the Delivery team , Construction Management team , and Schedule Lead , this role ensures that Project Controls delivers accurate, ... actionable insights 4. Provide analytical support to the Preconstruction team in review of General Contractor contracts...that early risks are transparently transitioned to the Delivery team 5. Proactively collaborate with the Schedule Lead… more
- Molina Healthcare (Santa Fe, NM)
- … team activities and troubleshooting. **Job Duties** + Research, review , and decipher state-specific Medicaid and Medicare reimbursement methodologies for ... **Job Description** **Job Summary** The Lead Analyst, Reimbursement is responsible for administering complex...to accurately request and analyze impact reports of affected claims . + Analyzes, interprets, and maintains configurable tables and… more
- Meta (Santa Fe, NM)
- …for maintaining Integrated Master Schedule (IMS) including reporting to site team , leadership and cross-functional partners 5. Lead the identification ... closely within the DEC (Design, Engineering and Construction) Business Controls team and various internal departments including Site Project Management teams,… more
- Cognizant (Santa Fe, NM)
- **About the role** We are looking for Test Lead with 10+ years of QA experience who have good exposure and understanding of personal lines Insurance (Auto or Home). ... the following responsibilities. **In this role, you will:** + Review and understand complex test plan/design to validate the...to solve straightforward problems, seeking input and guidance from team members. + Works with more junior members to… more
- Molina Healthcare (Santa Fe, NM)
- …work PST hours. **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost ... analytic / programming tools. + Coordinates and oversees report generation by team members and distribution schedule to ensure timely delivery to customers, ensuring… more
- GE Aerospace (Santa Fe, NM)
- …to clients regarding claim accuracy and fraud mitigation practices, as appropriate + Review and adjudicate reinsurance claims , responding to internal and client ... **Job Description Summary** Join our dynamic audit team at ERAC, a corporate holding of GE...holding of GE Aerospace, as a Reinsurance Auditor and lead audits that drive transparency, innovation, and integrity across… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …practices, procedures and controlled documents. + Lead weekly regulatory intelligence team meetings to include review and discussion of ad hoc query ... to the pharmaceutical environment. **Job Description** + Oversee the capture, review , and dissemination of global regulatory news, public commenting opportunities,… more
- Cardinal Health (Santa Fe, NM)
- …messages on an hourly basis. + Mentors new hires; assists + Assists management and team lead with motivating and coaching employees to succeed as needed. + ... done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as… more
- Sumitomo Pharma (Santa Fe, NM)
- …Authorities. + Managing responsibilities for direct reports within the commercial regulatory team for both product promotional review and product promotion ... the advertising and promotion of prescription drugs + Guide and/or lead regulatory agency interactions, including communications and meetings + Provide strategic… more
- Humana (Santa Fe, NM)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- **Associate Director, Small Molecule Analytical Development** + Lead and oversee phase appropriate method development and optimization for drug substance and drug ... product at CDMOs + Design and lead method validation and implementation activities for drug substance...support product development and regulatory submissions. + Author and review INDs, NDAs, and other regulatory submissions, ensuring accuracy,… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …behind initiatives** , fostering strong alignment with broader commercial objectives. + ** Lead Business Review Framework & Execution** + Own the **business ... effectiveness** . Additionally, the role collaborates with **Business Analysis team ** to ensure field teams have access to **actionable...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Prime Therapeutics (Santa Fe, NM)
- …of new or enhanced financial pricing strategies. This position will also lead highly complex financial pricing analyses and provide consultation and analytic insight ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more