- Sedgwick (Harrisburg, PA)
- …Contacts providers and attorneys to obtain clarification of documentation needed to support the preparation of Medicare Set-Aside allocations. + Creates ... Fortune Best Workplaces in Financial Services & Insurance RN Medicare Compliance Sr **PRIMARY PURPOSE OF THE ROLE:** To...culture. + Passionate about creativity. + Craves culture of support , both giving and receiving. + Thrives when everyone… more
- Elevance Health (Harrisburg, PA)
- …to transform federal health programs. The **Audit and Reimbursement Senior** will support our Medicare Administrative Contract (MAC) with the federal government ... and Human Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost...Senior will support contractual workload involving complex Medicare cost reports and Medicare Part A… more
- Humana (Harrisburg, PA)
- …weekend coverage + Develop collaborative relationships with Team and key partners within the Medicare Line of Business. + Support Home Solutions as needed + ... help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare… more
- Humana (Harrisburg, PA)
- …other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how ... contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana… more
- CVS Health (Blue Bell, PA)
- …remote.** Join a high-performing actuarial team supporting Aetna & SilverScript's Group Medicare Part D business. The primary responsibility of this role will be ... some of our largest employer group customers and the overall Group Medicare portfolio. The colleague will collaborate with business partners to provide sound… more
- Humana (Harrisburg, PA)
- …established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about ... its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage… more
- Humana (Harrisburg, PA)
- …clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing ... its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage… more
- UPMC (Pittsburgh, PA)
- …Actuary department is seeking an Actuarial Analyst to contribute to it's Medicare group line of business. This position applies knowledge of mathematics, probability ... of claim reserves (IBNR). + Forecasting. + Provide analytical support for rate development and filings. + Assist in...+ Assist in the preparation of financial analyses in support of the following functions: + Provide ad hoc… more
- Prime Therapeutics (Harrisburg, PA)
- …algorithms based upon relevant source data (eg clinical criteria, client criteria, Medicare LCD). Provides support for clinical client inquiries and internal ... Operations, IT, Quality, and Compliance as needed for program support . + Client support , including but not limited to, responding to inquiries, customization… more
- CVS Health (Harrisburg, PA)
- …data analysis to strategize and achieve operational targets for NCQA HEDIS and Medicare Stars * Provide analysis support for PIP reports to regulators, ... data-driven insights, and enhance the delivery of healthcare services. Provides support in completing regulatory reporting requirements and contributes to the… more
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