- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- The Associate Director, Congress and Medical Education Strategy & Execution is responsible for executing and contributing to the global medical strategy and ... with global and regional cross-functional stakeholders - including Global Medical Affairs, Clinical Development, Global Integrated Evidence & Innovation (GIE&I)… more
- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- **Job Summary** The Senior Director, Medical Communications, Nephrology & Immunology directs and provides strategic leadership for the global scientific ... directing the development and dissemination of all core scientific and medical content (eg, global slide decks, congress abstracts/presentations, publications, … more
- Sedgwick (Springfield, IL)
- …of related experience to include two (2) years of workers' compensation or claims related experience and three (3) years of EDI technical experience including ... or equivalent combination of education and experience required. JURIS or claims management application experience preferred. **Skills & Knowledge** + Demonstrates… more
- Elevance Health (Chicago, IL)
- …teams responsible for building, scaling, and maintaining platforms for: + Medical Cost Management ( claims review, payment integrity, utilization management, ... **Staff VP Engineering** - Medical Cost Management & Cost of Care **Location:**...for building advanced analytics platforms, AI/ML-driven decision support tools, claims optimization systems, and clinical insights platforms that enable… more
- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical ... and receives guidance where needed. Follows established guidelines/procedures. The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters,… more
- Humana (Springfield, IL)
- …coding certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, ... BS in healthcare or business-related field + Knowledge of internal Medical Coverage Policies and Claims Payment Policies + CAS claims processing experience +… more
- ICW Group (Lisle, IL)
- …**PURPOSE OF THE JOB** The purpose of this job is to supervise functions of claims internal controls and to monitor team activities with a focus on trends and ... is responsible for the development and execution of the Claims audit program, identifying trends and promoting continuous improvement....* We offer a competitive benefits package, with generous medical , dental, and vision plans as well as 401K… more
- Sedgwick (Springfield, IL)
- … claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as ... Ten (10) years of experience handling litigation including 5 years of claims management experience or equivalent combination of education and experience required.… more
- CVS Health (Springfield, IL)
- …a customer's data into meaningful and actionable information. This role is responsible for medical claims and economics reporting and analytics for a book of ... interpreting/analyzing all aspects of a customer's experience (financial results, medical management results, population health, effectiveness of incentive/wellness strategies,… more
- CVS Health (Springfield, IL)
- …requests. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits. Determines medical necessity, applicable ... Explains member's rights and responsibilities in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints… more