- Lincoln Financial (Hartford, CT)
- …**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
- Sedgwick (Springfield, MA)
- …(CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM) preferred. ... including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter… more
- Travelers Insurance Company (Hartford, CT)
- **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
- Otsuka America Pharmaceutical Inc. (Hartford, CT)
- …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
- Walgreens (Enfield, CT)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Highmark Health (Hartford, CT)
- …- 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
- CVS Health (Hartford, CT)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... every day. **Program Overview** Help us elevate our patient care to a whole new level! Join our Aetna...assessments that consider information from various sources, such as claims , to address all conditions including co-morbid and multiple… more
- Humana (Hartford, CT)
- …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
- Commonwealth Care Alliance (Springfield, MA)
- 023430 Clin Alli-Clin Assessment & CP **Position Summary:** Commonwealth Care Alliance's (CCA) Assessment unit conducts initial and ongoing face-to-face assessments ... and unmet needs. This individual works collaboratively with other members of the care team and staff in other departments as needed to support timely interventions… more
- Humana (Hartford, CT)
- …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
- Otsuka America Pharmaceutical Inc. (Hartford, CT)
- …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 (Hartford, CT)
- …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
- NASCO (Hartford, CT)
- …positive attitudes + Familiar with healthcare membership, billing, provider, benefit, managed care , claims , financial and reporting systems + High level ... triage and resolution. Must possess cross functional knowledge on NASCO's BlueCard, Claims , Membership and E-business product offerings; as well as NASCO service… more
- Humana (Hartford, CT)
- …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 (Hartford, CT)
- …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
- WTW (Hartford, CT)
- …NA leadership with refining the Industry focused model, prioritizing client & associate retention while quickly scaling extraordinary growth + Leads senior client ... ensures that we are exceeding all servicing expectations. Jointly responsible for claims , risk control and service delivery. Collaborate with other leaders, Client… more
- Humana (Hartford, CT)
- …The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work assignments are ... make an impact** **Required Qualifications** + 1 - 5 years or more of claims processing experience + Minimum of 1 year experience in conducting thorough root cause… more
- Humana (Hartford, CT)
- …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
- Humana (Hartford, CT)
- …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 (Hartford, CT)
- …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