- Humana (Springfield, IL)
- …+ 3 years of clinical RN Experience + Appeals nursing experience + Claims experience + Proficient with Microsoft Office products including Word, Excel and Outlook ... ** Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG guidelines + Working knowledge of ICD-9 or ICD-10,… more
- CVS Health (Springfield, IL)
- …healthcare fraud cases. - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, customer members, etc. - Facilitates ... to travel and participate in legal proceedings, arbitrations, depositions, etc. ** Preferred Qualifications** - Knowledge of New Jersey Medicaid - Credentials such… more
- Humana (Springfield, IL)
- …Pharmacy Solutions ensuring compliance with programmatic requirements, such as claims processing, prior authorization, formulary management and clinical programming ... candidates who currently live in or in the vicinity of Michigan.** ** Preferred Qualifications** + Bachelor's degree (or higher) in public health, Business… more
- Humana (Springfield, IL)
- …contributing to an organization focused on continuously improving consumer experiences ** Preferred Qualifications** + 2 years of Humana Experience + Knowledge of ... Humana Medical and Pharmacy Claims Processing Systems + Experience with data query/data programming applications (ie SQL, Python) + Knowledge of data visualization… more
- Zurich NA (Chicago, IL)
- …existing BU views. You'll lead deep dives into portfolio performance, claims development, and reserving, transforming complex technical data into clear, actionable ... in the Accounting or Finance areaOR + Zurich Certified Insurance Apprentice, including an Associate Degree with 7 or more years of experience in the Accounting or… more
- Humana (Springfield, IL)
- …individual Medicare Advantage plans. This includes: + Owning and improving our ESRD claims forecast process + Reviewing input assumptions and outputs of the ESRD ... modeling, pricing, rate filing, reporting & analysis, reserving or trending) ** Preferred Qualifications** + Strong technical skills, especially SQL, VBA, and… more
- Humana (Springfield, IL)
- …first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... to an organization focused on continuously improving consumer experiences ** Preferred Qualifications** + Medical management experience, working with health insurance… more
- Humana (Springfield, IL)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... and/or home health or post-acute services (such as inpatient rehabilitation). ** Preferred Qualifications** + Knowledge of the managed care industry including… more