- Centene Corporation (Springfield, IL)
- …teams to improve provider performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Identifies specific practice needs where ... Centene can provide support. + Develops, enhances and maintains provider clinical relationship across product lines. + Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards. + Ability to travel up to… more
- Elevance Health (Chicago, IL)
- …Prior experience with Cost of Care, provider network contracting, provider networks, claims , finance, and operations preferred. + Pharmacy actuarial experience ... strongly preferred _Corporate Title:_ _Staff VP Actuarial Cost of Care and Analytics_ For candidates working in person or remotely in the below locations, the salary* range for this specific position is $183,040 to $329,472 Locations: California; Illinois,… more
- Axis (Chicago, IL)
- …Development: Partner with the Excess Casualty Leadership and various business partners ( Claims , Actuarial, Distribution, and Operations ) and to support and ... influence the strategic direction of the Construction, Manufacturing, Transportation, and other areas. Provide insights on market trends and emerging risks to help refine underwriting practices. + Strategic Responsibilities: Contribute to the development and… more
- Dragonfly Health (IL)
- …teams to improve provider onboarding and training. + Monitor provider operations including claims , billing, redelivery issues, and service standards. ... + Maintain CRM records and generate performance reporting and scorecards. + Support onboarding and training of new Provider Services team members. + Serve as a specialist for non-core business lines and large accounts. + Provide weekend coverage on a rotating… more
- R1 RCM (Chicago, IL)
- …**It's** **a plus if you bring:** + Experience with healthcare operations /RCM (FHIR/HL7, claims , denials) and/orregulated industries with compliance needs ... prevention, payments). Your software will be deployed within clinical and financial operations where Foundry is already used to optimize hospital flow and predict… more
- MetLife (Aurora, IL)
- …in the lives of our customers and our communities. The Global Technology & Operations group (GTO) is a diverse team of engineers, developers, business analysts, ... claims analysts and project managers who collaborate to create...Build a Confident Future (Key Responsibilities): The PFML Senior Operations Quality Analyst is responsible for: * Evaluating and… more
- Cardinal Health (Springfield, IL)
- …is responsible for verifying patient insurance and benefits, preparing and submitting claims to payers, correcting rejected claims , following up on unpaid ... data to insurance providers + Researching and appealing denied and rejected claims + Preparing, reviewing, and transmitting claims using billing software… more
- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- The Associate Director, Strategic Planning & Operations will support the assets of varying lifecycle stages in the relevant therapeutic area portfolio. This role is ... who in turn reports into the Medical Excellence & Operations Lead. **Job Description** **Key Responsibilities Include:** **Strategic Planning...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- **Job Summary** The Associate Director, Quality Operations will lead initiatives that drive operational excellence, enhance risk management practices, and optimize ... organization. This role is instrumental in ensuring that quality operations are efficient, compliant, and aligned with strategic business...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- Director, Training Management Operations Lead The Director, Training Management Operations Lead, is a senior leader within the Learning Center of Excellence ... responsible for overseeing the end-to-end management of global training operations , ensuring compliance with regulatory requirements, operational efficiency, and… more