• Director, Appeals & Grievances (Medicare…

    Molina Healthcare (Rochester, NY)
    …Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from ... processed in accordance with local Health Plan requirements * Works with Claims , Configuration, Contracting, Provider Data Management, and other business partners to… more
    Molina Healthcare (07/18/25)
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  • Claims Team Manager , Workers Comp

    Zurich NA (Albany, NY)
    Claims Team Manager , Workers Comp 126104...not near a Zurich office. Enjoy the benefits of remote work while maintaining the option to collaborate in-person ... in-office attendance should be expected. Zurich is seeking an experienced Workers' Compensation Claims Team Manager with specialized expertise in the New York… more
    Zurich NA (08/08/25)
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  • Manager , Claims Research…

    Humana (Albany, NY)
    …first** Are you ready to lead and make a real impact? Join us as our Manager , Claims Research & Resolution-a key leadership role where you'll drive critical ... claims operations, oversee complex investigations, and ensure fair settlements...on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training… more
    Humana (08/09/25)
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  • Marine Claims Specialist II

    Zurich NA (Albany, NY)
    Marine Claims Specialist II 126114 Zurich North America is...preferred) to join our team! We are open to remote work for the right candidate located within the ... hiring a Marine Claims Senior Claims Specialist Role (With Hull...assigned to outside contractors. Departs from approved vendors with manager approval, where in the best interests of the… more
    Zurich NA (08/08/25)
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  • Manager , Operations -System Operations…

    Molina Healthcare (Syracuse, NY)
    …leadership and direction to MMS Operational Units management staff (eg, Claims Processing, Provider Services, Provider Enrollment, Finance, Managed Care Provider ... equivalent experience **Required Experience** 3 years supervision/management experience in Claims Processing or Provider Services environment and/or any high volume… more
    Molina Healthcare (07/31/25)
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  • Payment Integrity Subrogation Manager

    Molina Healthcare (Yonkers, NY)
    **Job Summary:** The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare, and Marketplace ... across a wide range of subrogation case types-including automobile-related claims (eg, no-fault/PIP), workers' compensation, general liability, medical malpractice,… more
    Molina Healthcare (07/23/25)
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  • RN Care Manager Remote with field…

    Molina Healthcare (NY)
    …organized and analytical thinking. Experience with Medicare/Medicaid, MS 365 and familiarity with claims is highly preferred. The Case Manager must be able to ... encouraged to apply. Further details to be discussed during our interview process. Remote with 10% travel to member's home or facility Work schedule Monday through… more
    Molina Healthcare (08/08/25)
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  • Manager , Provider Network Administration…

    Molina Healthcare (Buffalo, NY)
    …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims , Provider Services and Contracting. * Identifies issues, resolves problems… more
    Molina Healthcare (08/13/25)
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  • Manager , Enrollment - REMOTE

    Molina Healthcare (Buffalo, NY)
    …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... **Knowledge/Skills/Abilities** + Has direct oversight of enrollment, premium billing and reconciliation processes and all related staff + Coaches and mentors direct staff, including goal setting and score card development + Monitors and enforces compliance… more
    Molina Healthcare (08/01/25)
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  • Revenue Cycle Coordinator IV - Remote

    University of Rochester (Rochester, NY)
    …resolution and adjudication, including refund of credits + Review and advise supervisor or manager on trends of incorrectly paid claims from specific payers + ... independent decisions as to the processes necessary to collect denied insurance claims and resolve billing issues. Must track payer/billing issues that affect… more
    University of Rochester (08/07/25)
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