- 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 ... completed documentation from providers to ensure accuracy, completeness, adherence to quality assurance standards. + Determine the outcome of involvement to include… 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 ... multiple Account Representatives. + Ensures compliance with all applicable Quality initiatives. **QUALIFICATIONS** Education & Licensing Ten (10) years related… more
- Nestle (New York, NY)
- …channeling our growth-minded spirit to set new standards in global coffee culture. Quality , sustainability, diversity, and inclusion are core to who we are and ... sites). + Determine retail location readiness to open through Risk Assessments. + Enforce risk prediction and...as all applicable external regulatory requirements. + Initiates WC Claims to insurance provider. + Ensure all locations have… more
- Guardian Life (New York, NY)
- …leaders. Our solutions and actions are critical to Guardian's revenue growth, risk management and customer experience. Guardian created a Data Science Lab (DSL) ... Define north-star metrics (eg, straight-through-processing %, cycle-time reduction, cost-to-serve, accuracy/ quality , call deflection) and track value realization with executive… more
- CVS Health (Albany, NY)
- …work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information ... Pharmacy Payment Compliance reporting using SQL and SAS. You will continuously improve quality controls and accuracy of reported data, looking for ways to further… more
- Humana (Albany, NY)
- …higher quality and operational efficiency. + Ensure enrollment and claims processes comply with regulatory requirements and guidelines. + Partner with ... Enrollment Period (AEP). + Utilize tools such as Availity to streamline claims submission, eligibility verification, and authorization processes. + Directly lead a… more
- GE Vernova (Saratoga Springs, NY)
- …may be required but this is typically with guidance. Performance Measurement: * Schedule quality * Cost forecasting quality * Schedule forecast quality * ... Initiate actions to improve health and safety where needed Quality & Lean: * Comply with Quality ...validates accuracy of estimates + Communicates schedule and cost status/forecasts/ risk to functional cost owners and drives/supports risk… more
- BronxCare Health System (Bronx, NY)
- …and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation ... of the Bronx-Lebanon Hospital Center (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and… more
- Molina Healthcare (Yonkers, NY)
- …responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other Core Ops areas of ... regulatory compliance adherence (in conjunction with functional counterparts) and quality metrics. Accountable for offering innovative guidance and solutions to… more
- BronxCare Health System (Bronx, NY)
- …and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation ... of the BronxCare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and… more