- Elevance Health (Waukesha, WI)
- …of managerial experience is strongly preferred + Experience with IRE/Maximus and Medicare compliance , programs, guidelines, and processes are strongly preferred. ... and operational and plan risk, ensures quality, and regulatory compliance . This role specifically oversees the IRE Team. **How...regulated audits. + Oversight of the IRE portions of Medicare audits and universe production. + Serves as a… more
- Sedgwick (Milwaukee, WI)
- …and laws + Knowledge of medical terminology for claim evaluation and Medicare compliance + Knowledge of appropriate application for deductibles, sub-limits, ... SIR's, carrier and large deductible programs. + Strong oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Strong organizational skills + Strong interpersonal skills + Good negotiation skills +… more
- Prime Therapeutics (Madison, WI)
- …analytical skills **Preferred Qualifications** + PBM/health care experience related to Medicare , Medicaid, Commercial, HIM + Certified Compliance and Ethics ... passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Risk Assessment and Oversight) - Remote **Job Description** The Senior… more
- CVS Health (Madison, WI)
- …talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part of a specialized team ... who will focus on educating existing Medicare members on available plan offerings to help meet...selling applicable products to existing members. + Maintaining high compliance commitment and standards with a robust knowledge with… more
- Humana (Milwaukee, WI)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CVS Health (Madison, WI)
- …Leads the strategy, design, development and life cycle management of Aetna Medicare products that serve Medicare Advantage populations, including Chronic Care ... care objectives. Working cross-functionally with Duals Center of Excellence, clinical, compliance , analytics and network teams, the Senior Manager drives innovation… more
- Humana (Madison, WI)
- …appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana ... experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Madison, WI)
- …medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD represents ... experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Madison, WI)
- …to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and ... analyzes state and federal regulatory rules, contracts, and other guidance to assess compliance and support building regulatory compliance audit procedures. * At… more
- Molina Healthcare (Green Bay, WI)
- …and resolve. **Knowledge/Skills/Abilities** Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to ... performance of internal compliance audits, represent Corporate Operations on external regulatory or...a cadence for assessing and adjusting * Monitor internal compliance of Corporate Operations units via establishment of an… more