- Evolent (Albany, NY)
- …across Evolent's value-based care platform. This role ensures consistent, high-quality adjudication of cardiology decisions and serves as a strategic liaison between ... clinical teams and clients. The VP will serve as a key strategic thought-partner in shaping Evolent's cardiovascular medicine programs. The VP must be able to incorporate clinical, operational, and business inputs in designing and refining our programs to… more
- Price Chopper (Glens Falls, NY)
- …medications, including maintenance of necessary records, accurate third party adjudication and patient charges, and inventory management. Counsels patients and ... medical providers regarding the nature and use of drugs, dosage, drug interactions, and side effects, as well as, monitors the health and progress of patients to ensure compliance and to optimize therapies. Participates in patient centered services including… more
- Molina Healthcare (NY)
- …NetworX Pricer configuration modules (Benefits, Provider Contracts, Pricing, Claims Adjudication ). **Preferred Education** + Graduate Degree or equivalent experience ... **Preferred Experience** + Strong business writing skills proficient user of Microsoft Products including Word, Excel, Outlooks, Teams, SharePoint, PowerPoint, and Visio + Advanced knowledge of Excel + SQL knowledge + Coding certification To all current Molina… more
- TD Bank (New York, NY)
- …of various risk segmentation strategies including, but not limited to: adjudication , account management, exposure management, risk segmentation, and financial return ... optimization. This job provides critical information, interpretative, and detailed analysis, and deploys critical credit risk rational strategies that ensure the decisions are made within the TD risk appetite and adhere to all governmental requirements and… more
- Centene Corporation (Queens, NY)
- …implementation and optimization of health plan operations systems (eg, claims adjudication platforms, CRM tools). + Drive digital transformation initiatives to ... streamline operations. + Understand and execute on key operational needs of assigned business unit or product lines. + Oversight of relevant corporate business units to ensure the development and implementation of operational work processes and systems within… more
- MetLife (New York, NY)
- …Responsibilities * Date science in Dental: Contributions to underwriting models, claims auto- adjudication logic and models, fraud waste and abuse analyses and models ... (mostly provider-related), dental network analyses, consumer analytics, network expansion analytics and much more. * Leads and contributes to data analysis and modeling projects from project/sample design, business review meetings with internal and external… more
- Hubbard Broadcasting (Rochester, NY)
- …is subject to pre-employment driving record background check. A conviction, violation pending adjudication , or adverse driving record more than 3 years old or does ... not meet the major violation definition per company policy will not, on its own, disqualify an applicant. The company will use background check information in a confidential, non-discriminatory manner consistent with applicable federal, state and local law.… more
- Bassett Healthcare (Cooperstown, NY)
- …and insurance information. + Profiles and processes prescription including insurance adjudication in a timely manner. As necessary arranges for interdepartmental ... payment + Processes electronic prescriptions, IVR refill requests and prescriber refill responses in a timely manner with accuracy. + Alerts pharmacist to any DUR, allergy warnings or drug interactions displayed in pharmacy processing software when processing… more
- KPH Healthcare Services, Inc. (Alexandria Bay, NY)
- …of pharmacy technology - included is product dispensing, data entry, and adjudication workflow steps + Inventory management - proficient in inventory management ... including ordering & receiving processes, inventory freshness; proficient with return to stocks and cycle counting + Regulatory & Operational Compliance - Proficient in all state and federal regulations ensuring compliance with the law; understands and ensures… more
- Bloomberg (New York, NY)
- …part of the role, with key work spanning ownership around consensus management, adjudication , and instruction and task design. The team is a critical partner in ... ensuring the stability and growth of the company which relies on bringing new technology to customers with increased interests in Artificial Intelligence. **We'll trust you to:** + Build strategies to analyze processes and data engineering questions to ensure… more