- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- …federal laws, regulations and guidelines including PhRMA Code on Interactions with Healthcare Professionals as well as complying with all OAPI standards and policies ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Highmark Health (Springfield, IL)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... industry regulatory changes and assess their potential impact on Claims Operations, Customer Service and other operational areas processes...Health Insurance Industry + 3 - 5 years the Healthcare Industry + 3 - 5 years in Lean/Six… more
- Prime Therapeutics (Springfield, IL)
- …Analyze data to find suspicious patterns and outliers using knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability. + Contact ... Education Level Bachelors + Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the United States without the… more
- Elevance Health (Chicago, IL)
- …executing health services research studies in order to identify and solve pressing healthcare issues as part of Elevance Health's Public Policy Institute. **How you ... of statistical results. + Analyze health care data, including claims , clinical data, national survey data, and other large...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Evolent (Springfield, IL)
- …Be Doing:** Job Description **Analyst, Integration Quality** Integration testing in the healthcare ecosystem requires complete end to end testing in the specialty ... work experience + General knowledge of data flow and healthcare end to end system landscape + Good knowledge...Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1… more
- Walgreens (Harvard, IL)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Humana (Springfield, IL)
- …an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and ... researching medical claims + Proficient in Microsoft Office (Word, Excel, Access,...strong relationship-building and stakeholder engagement skills + Familiar with healthcare industry regulations or adjacent sectors **Preferred Qualifications** +… more
- Guidehouse (Chicago, IL)
- …client business problems, which include but are not limited to medical and pharmacy claims (open and closed), formulary and managed care data, and EMR data. + ... to IQVIA, Komodo, Compile, MMIT/Norstella, Symphony Health, Truven/Merative, and Definitive Healthcare . + Lead internal and external discussions to understand and… more
- Walgreens (Itasca, IL)
- …the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Medtronic (IL)
- …can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You'll lead with purpose, breaking down ... Clinical Expert + Translates complex technical messaging, dispels competitive claims , resolves complex technical issues, and maintains customer relationships through… more