- Humana (Boston, MA)
- …+ 3+ years of SQL experience, preferably in SSMS. **Preferred Qualifications** + Medicare Advantage experience. + Experience with SQL and VBA highly preferred. + ... Information** + This role is part of a team that owns the Medicare Advantage pricing methodology and supporting tools in the ecosystem. Travel: While this… more
- Humana (Boston, MA)
- …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... experiences **Preferred Qualifications** + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma and/or Project Management… more
- Humana (Boston, MA)
- …expert on the End Stage Renal Disease (ESRD) population for Humana's individual Medicare Advantage plans. This includes: + Owning and improving our ESRD claims ... technical skills, especially SQL, VBA, and Databricks/Python + Individual Medicare Advantage experience + Knowledgeable on ESRD population **Additional Information**… more
- Humana (Boston, MA)
- …This role will support a few tools used within our Individual Medicare Advantage pricing and internal reporting process. This includes: + Helping make ... Qualifications** + Strong technical skills, especially SQL and VBA + Individual Medicare Advantage experience Travel: While this is a remote position, occasional… more
- Molina Healthcare (Cambridge, MA)
- …administration of contracts with State and/or Federal governments for Medicaid, Medicare , Marketplace, and other government-sponsored programs to provide health care ... (5) years' experience in a managed care environment (including Medicare , Medicaid and other State governed plans) + Minimum...plans) + Minimum of four (4) years of health insurance experience + Minimum of two (2) years of… more
- Point32Health (Canton, MA)
- …that optimize performance across our provider networks serving Point32Health's Medicare , Medicaid, Duals and Commercial small and individual group markets. ... and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product members. This individual will lead the… more
- Sedgwick (Boston, MA)
- …Certified as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | General Liability BI | Captive | Remote As a Claims ... Injury General Liability Claims Examiner** working within **commercial (** **captive) insurance program(s)** ? Are you skilled in **coverage determination** ,… more
- Humana (Boston, MA)
- …+ Accounting/Finance knowledge/experience + Advanced SQL or similar + Medicare /Medicaid experience + Data architecture/solution architecture experience + Project ... with Service Ops (claims, B&E, etc. **Preferred Qualifications** + Health insurance operations expertise + Value based provider arrangement experience + Certified… more
- Sodus Rehab & Nursing Center (Everett, MA)
- …+ Great Benefits Package + Professional Growth & Stability Benefits: + 401(k) + Dental insurance + Health insurance + Paid time off + Vision insurance ... progress notes and re-certifications per facility policy. + Demonstrates working knowledge of Medicare Part A PPS case management + Complies with Federal and State… more
- Sedgwick (Boston, MA)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claim Examiner - Liability | Remote **PRIMARY PURPOSE** : To analyze complex or ... limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests… more