- City of New York (New York, NY)
- …Bureau of Law and Adjustment (BLA), negotiates and approves all monetary settlement of claims and lawsuits involving the City of New York. BLA investigates and, when ... in the best interest of the city, settles pre-litigation claims for and against the City of New York....Based on the BLA's review and investigation of any claim , the City of New York may extend an… more
- Philadelphia Insurance Companies (New York, NY)
- …the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an ... Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life… more
- MetLife (New York, NY)
- …Key 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… more
- Centene Corporation (New York, NY)
- …to providers that would improve utilization and health care quality. + Review claims involving complex, controversial, or unusual or new services in order to ... determine medical necessity and appropriate payment. + May develop alliances with the provider community through the development and implementation of the medical management programs. + As needed, may represent the business unit before various publics both… more
- AIG (New York, NY)
- …American Commercial, and Specialty portfolios. + Work closely with actuarial, claims , and other functions, integrating catastrophe modelling insights into day-to-day ... business, and portfolio optimization strategies. + Carry out other modelling business activities including event response, business planning, budgeting, profit studies, portfolio optimization, reinsurance purchasing, and other exercises where catastrophe risk… more
- Molina Healthcare (Buffalo, NY)
- …advanced SQL queries to extract, validate, and analyze healthcare data, including claims , pharmacy, and lab datasets. + Build and maintain efficient ETL pipelines ... to support ongoing reporting and analytics workflows. + Utilize Databricks and Snowflake to develop scalable data pipelines and analytical datasets. + Create and maintain Power BI dashboards to deliver insights on utilization, outcomes, and cost drivers across… more
- CVS Health (Albany, NY)
- …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 (Albany, NY)
- …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 (Albany, NY)
- …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
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …related field **Experience:** + Required: 1 year experience using the RxIQ claims adjudication platform + Preferred: 2 Years experience with Health Care, Insurance ... wage requirements. Connect With Us! (https://kphcareers-kphhealthcareservices.icims.com/jobs/14032/ senior -benefit-operations-specialist/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336031866) **Job Locations** _US-NY-Gouverneur_ **Posted… more