- Robert Half Legal (Farmington Hills, MI)
- …A prominent Michigan-based organization in the insurance sector is looking for a dynamic Claims Director . This position is ideal for an experienced leader with ... expertise in claims management, litigation oversight, and operational strategy. *This is...to ensure accuracy and compliance. + Support the executive director and collaborate with leadership on organizational strategy and… more
- Molina Healthcare (Sterling Heights, MI)
- **Job Description** **Job Summary** The Network Solutions Director is responsible for leading a team designing and executing new solutions. The position requires the ... lead a diverse team of technical experts and business analysts. The Solutions Director will interface with IT and business leaders to enable enterprise wide… more
- Molina Healthcare (Sterling Heights, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... the development, implementation and maintenance of provider data in the claims payment system. * Supports critical business strategies by providing systematic… more
- Molina Healthcare (Sterling Heights, MI)
- …activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- Corewell Health (Southfield, MI)
- …activities such as personnel file requests, subpoena responses, unemployment claims processing, internet usage reporting, internal review processes, exit interviews, ... team member qualifications including health requirements, regulatory audits, team member investigations, verifications of employment, etc. + From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course… more
- Molina Healthcare (Sterling Heights, MI)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Molina Healthcare (Sterling Heights, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems ... leadership based on feedback rom assigned MHI attorney. * Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting. * Advises… more
- Integra Partners (Troy, MI)
- …UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director ) with administrative and non-clinical tasks related to processing Utilization ... codes + Verify eligibility and claim history in proprietary claims platform + Verify all necessary documentation has been...external sources + Other duties as assigned by UM Director + Strong organizational skills, ability to adapt quickly… more
- Select Medical (Ypsilanti, MI)
- …the Human Resources department in coordination with the regional Human Resources Director and the corporate Human Resources team, payroll department and recruitment ... and/or compliance purposes. + Processing and maintaining all workers' compensation claims , unemployment requests, FMLA and leaves of absences. + Providing services… more
- Elevance Health (Dearborn, MI)
- …service as required. + Conduct business in a professional manner. + Troubleshoot claims issues. + Investigate and research to resolve customer complaint problems and ... required licensure activities supervised by the Clinical Manager or Clinical Director . **Preferred Qualifications:** + Experience in settings that include inpatient,… more
- Molina Healthcare (Sterling Heights, MI)
- …medical management, network contracting and provider relations, member services, claims management, payment integrity, pharmacy, quality and risk adjustment. * ... practice experience, and at least 2 years as a medical director in managed care organization supporting utilization management/quality program management, or… more