- Trinity Health (Maywood, IL)
- …necessary to meet project outputs. + Verifies that request for payments, claims and scope changes are accurate, justified and/or compliant. + Demonstrates effective ... planning by anticipating problems and resolving them before they adversely impact projects; sets appropriate priorities to achieve desired outcomes. + Complies with hospital guidelines and standards and all appropriate government codes and regulations; ensures… more
- CVS Health (Springfield, IL)
- …compliance impacting plan sponsors. + Collaborate with internal departments-including claims , customer service, and client management-to ensure effective issue ... resolution and maintain strong working relationships. + Stay informed about industry trends, regulatory changes, and best practices related to self-funded plans. **Required Qualifications** + A minimum of 7 years of relevant experience in a TPA (Third Party… more
- Western Digital (Springfield, IL)
- …business models + Familiarity with legal guidance for marketing related claims and/or product liability matters + Knowledge of product regulatory matters ... related to hardware or software products SKILLS + Strong proficiency in drafting contracts or writing persuasively for a third-party audience + Attentively listens to others and encourages the open expression of diverse ideas and opinions + Provides timely and… more
- Highmark Health (Springfield, IL)
- …5 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 3 years of project leadership ... in a complex, matrixed environment (payer and/or provider preferred) + 3 years of providing analytical consultation to clinical, administrative, operational and financial stakeholders **Preferred** + None **LICENSES or CERTIFICATIONS** **Required** + None… more
- MetLife (Chicago, IL)
- …and possess in-depth knowledge of plan designs, benefit features and how claims are paid * Strong understanding of industry marketplace and legal developments. ... * Proactive customer focused mindset * Strong focus on customer satisfaction and obtaining results * Proven ability in building relationships both internally and externally with people at all levels of the organization * Ability to analyze data to influence… more
- AbbVie (North Chicago, IL)
- …that make use of real-world data bases, eg electronic health records, insurance claims databases, and/or registries. + Play a key role in the cross-functional team ... and ensure that study results and conclusions are scientifically sound, clearly presented, and consistent with the statistical analyses provided. Ensure timely and quality statistical deliverables. Assist other MA&HTA Statistics colleagues or represent MA&HTA… more
- Highmark Health (Springfield, IL)
- …review, assisting in navigating a complex regulatory environment, working with claims data, performing financial analyses, and supporting the presentation of ... strategic recommendations to leadership and stakeholders. Secondary responsibilities will also include supporting formulary coding, implementation, and testing processes in partnership with the pharmacy benefits manager. The successful candidate will possess… more
- AIG (Chicago, IL)
- …claims adjusters to embody AIG's corporate values + Identify and escalate complex claims to senior management with significant coverage, loss, or other issues ... + Support departmental initiatives focusing on improved claim processes, claims results and financial results + Lead training and development initiatives to… more
- The Hartford (Naperville, IL)
- …of Claims personnel at all levels, including but not limited to Claims senior leadership, field operations, data science staff, and business segment leaders. ... too. Join our team as we help shape the future. The Liability Claim Performance Analytics group is seeking a Performance Analytics Consultant to support operational… more
- CVS Health (Springfield, IL)
- …and key litigation activities. + Utilizing legal skills to oversee and manage claims against CVS from the initiation of suit through resolution. + Managing all ... identify the litigation strategy in every case assigned. + Creating a plan for claim evaluation to most efficiently resolve or defend cases against CVS while working… more