- Rising Medical Solutions (Chicago, IL)
- …providing strategic direction for Rising's Specialty Services unit involving complex /large medical claims ; analyzing and optimizing bill review procedures ... As our Director of Specialty Bill Review Services,...an expert witness as required. + Research and answer complex questions regarding CPT, ICD-9, HCPC and other codes,… more
- Humana (Springfield, IL)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director (Staff Geriatrician or Physician with Ten (10) ... Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of...Current and ongoing Board Certification an approved ABMS Medical Specialty + No current sanction from Federal or State… more
- Humana (Springfield, IL)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of...Current and ongoing Board Certification an approved ABMS Medical Specialty + A current and unrestricted license in at… more
- CVS Health (Springfield, IL)
- …Strategy team under the Pharmacy Benefits Management (PBM) business unit. The Director , Network Strategy will partner with senior executives on developing how we ... requiring partnership with advanced analytic and financial talent. The director will be a data-driven leader with the ability...be a data-driven leader with the ability to distill complex analyses and concepts into insights that are packaged… more
- Humana (Springfield, IL)
- …Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of… more
- AbbVie (Mettawa, IL)
- …payer formulary access that maximize net sales for assigned brands. Identify through claims analysis, market dynamics that shape brand demand and build models to ... for the issue at hand. . Aligning and standardizing business logic, claims analysis methodologies and data management with MABI and Brand stakeholders. Recommending… more
- EPAM Systems (Chicago, IL)
- …be the perfect opportunity for you to join EPAM as a **Managing Director , Insurance Advisory** . Scroll down to learn more about the position's responsibilities ... operational capabilities **Requirements** + Prior experience as a Managing Director (Partner, or equivalent level) with primary client relationship responsibility… more
- AbbVie (Mettawa, IL)
- …payer formulary access that maximize net sales for assigned brands. Identify through claims analysis, market dynamics that shape brand demand and build models to ... insights and analytics for understanding and recommending the development of any Specialty Pharmacy, Health Plan and PBM strategies across payer channels through… more
- HNTB (Chicago, IL)
- …a century, we have been delivering solutions for some of the largest, most complex infrastructure projects across the country. With our historic growth, it is an ... leadership and project controls expertise. Closely works with project manager/ director , clients, sub-consultants, and project stakeholders to successfully lead all… more
- Travelers Insurance Company (Springfield, IL)
- …of business. In this role the consultant will be working with our largest, most complex and all lines accounts. This role reports to the Risk Control Field ... Director or Managing Risk Control Consultant. This job does...business. + Build and maintain productive relationships with Underwriting, Claim , Risk Control Specialists, and Brokers to service customers… more
- Wolters Kluwer (Springfield, IL)
- …relevant, clinically meaningful data used in prescribing, dispensing, administration, and claims adjudication. You will understand and apply knowledge of database ... and qualification of content. You will report to the Associate Director , Clinical Content. **RESPONSIBILITIES** + Responsible for creating and revising accurate,… more
- Astellas Pharma (Northbrook, IL)
- …Lead, US Market Access Insights & Strategy who in turn reports to Senior Director , US-C Insights and Strategy. + Requires close collaboration with US Health Systems, ... data sources, such as formulary tools, pricing databases, and claims data sources. + 1-3 years of market research.../ quantification of risk. + Ability to deal with complex business issues by identifying and applying the correct… more