- Highmark Health (Buffalo, NY)
- …the Organization's gain/ risk share programs, with a goal of maximizing quality and ROI for the Organization. This includes analyzing performance reports and data ... be directly responsible for outcomes of providers contracted in the Organization's gain/ risk share arrangements and is a highly skilled expert in practice… more
- Two95 International Inc. (New York, NY)
- …navigate and do the analyses * Lead the analytical-interrogation of their EMR/EHR and/or claims data to perform data quality checks * Partner with our ... * Lead the discovery of the client's EMR/EHR and/or claims data environment so we can efficiently and effectively...similar * Deep familiarity with HEDIS & CMS care quality measures; experience implementing both HEDIS and CMS measures… more
- Walmart (Greece, NY)
- …deficiencies andproviding process improvement leadership to ensure a high quality customer experience Provides supervision and development opportunities for hourly ... Partners in collaborative efforts with other investigative entities Monitors safety and risk controls within a facility by ensuring an effective safety program is… more
- Sedgwick (Albany, NY)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... & Insurance Contents Adjuster **PRIMARY PURPOSE** : To handle losses and claims for property and casualty insurers. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** +… more
- Sedgwick (New York, NY)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... Adjuster - Northeast Region **PRIMARY PURPOSE** **:** To investigate losses or claims internationally on any size National Account (Maintaining a minimum of five… more
- Sedgwick (New York, NY)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... Executive General Adjuster - Northeast Region **PRIMARY PURPOSE** : To investigate claims internationally of any size or complexity, against insurance or other… more
- Evolent (Albany, NY)
- …insights from product strategy analyses and translating them to complex risk -based contract development, and they will partner closely with executives across ... value-based care pursuits. + Support the development of capitated risk partnerships, focusing on cost and use trends, and...and estimate Evolent's ability to reduce costs and improve quality . + Develop models to quantify and articulate value… more
- Molina Healthcare (Albany, NY)
- …and you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer ... grievances, and member communications. * Exposure to downstream domains: Enrollment, Claims , Pharmacy/PDE, Network, Stars quality metrics. * Proven record… more
- Molina Healthcare (Syracuse, NY)
- …the organizational health care costs for all lines of business and directly impacting Risk Revenue and Quality Compliance. Partner with VP Encounter to ensure ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for establishing enterprise-wide strategy, governance, and oversight of… more
- HUB International (Melville, NY)
- …owned global insurance broker, providing a broad array of property, casualty, risk management, life and health, employee benefits, investment and wealth management ... will:** + Discuss benefit strategy, program alternatives, markets, vendors and appropriate risk management solutions with clients as part of the annual HUB client… more