- CVS Health (Raleigh, NC)
- …with complex systems and solving challenging analytical problems + Previous medical /dental healthcare experience, claim domain knowledge and proficiency in ... a highly skilled and experienced Senior Product Owner to join our Commercial Claim Adjudication engineering team. As a Senior Product Owner, you will contribute to… more
- Cardinal Health (Raleigh, NC)
- …team to ensure timely and accurate resolution of outstanding insurance claims . This role leads strategy development, performance monitoring, and process improvement ... rates, and collection targets. + Develop and implement processes to improve claim resolution timelines and reduce denials and underpayments. + Provide training,… more
- Humana (Raleigh, NC)
- …and reporting. Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. Maintain dashboards to communicate key trends to ... community and help us put health first** Design and maintain Medicaid claims analytics dataset using Databricks. Conduct in-depth analysis of healthcare claims… more
- Elevance Health (Durham, NC)
- …the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. **How ... audits. + Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment &… more
- Sedgwick (Raleigh, NC)
- …PURPOSE OF THE ROLE:** While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical ... and a successful return to work through advocacy, communication and coordination of medical services. **ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic… more
- Otsuka America Pharmaceutical Inc. (Raleigh, NC)
- **Job Summary** The Senior Manager, Medical Writing (MW) will be responsible for leading and advising on medical writing processes and activities for individual ... of operational plans, budgets, and innovative solutions for all medical writing activities across OPDC. He/she will also lead...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Raleigh, NC)
- …medicines for those with CNS disorders, we are seeking a skilled and experienced Medical Director of CNS Early Assets, Global Medical Affairs, responsible for ... certain assets within the broader CNS TA portfolio Medical Affairs (both US and Global), with a specialization...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Humana (Raleigh, NC)
- …of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, ... part of our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records… more
- Amgen (Raleigh, NC)
- …insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution + Educate offices using approved materials + Review ... pharmaceutical industry in managed care, clinical support, and/or sales + Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge… more
- CDM Smith (Winston Salem, NC)
- …Assist the project team in developing and maintaining a project risk register. Claim management: Early support for claims and disputes on the project. ... Identify contractual requirements to maintain and prosecute claims , and assist project team in managing to those requirements. Ensure that proper documentation is… more