- Centene Corporation (Richmond, VA)
- …a Monday - Friday; 2:00 pm - 10:30 pm EST, schedule.** **Position Purpose:** The Senior Pharmacy Resolution Specialist will act as a subject matter expert and ... everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is...handles more complex pharmacy issues and respond to escalated calls from members,… more
- CVS Health (Richmond, VA)
- …Trifacta, Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health ... to join our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team....You will work with a collaborative, close-knit team on pharmacy and member specific claims data including,… more
- Elevance Health (Norfolk, VA)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying ... **Investigator Senior ** **Hybrid 1:** This role requires associates to...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Elevance Health (Richmond, VA)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- Elevance Health (Richmond, VA)
- …or related experience is preferred. + Experience with health plan administrative databases ( pharmacy and medical claims ) and/or other big datasets is preferred. ... **Researcher Senior ** **Location:** This role requires associates to be...of statistical results. + Analyze health care data, including claims , clinical data, national survey data, and other large… more
- CVS Health (Richmond, VA)
- …of PBM profit levers, underwriting and financial models. + Understanding of healthcare and pharmacy claims data and common tools used to manipulate data. + ... opportunity to join it's CVS Health's leadership team as a Director, Pharmacy Benefit Management (PBM) Underwriting, Analysis and Strategy. In this role, you… more
- Humana (Richmond, VA)
- …with business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, ... or data requires an in-depth evaluation of variable factors. As the Senior Clinical Compliance Professional , you will develop and/or evaluate compliance… more
- Guidehouse (Arlington, VA)
- …address client business problems, which include but are not limited to medical and pharmacy claims (open and closed), formulary and managed care data, and EMR ... audiences (including multiple levels of management and external clients) in a professional business environment. + Experience in managing independent as well as… more
- Genesis Healthcare (Bluefield, VA)
- …to improving health outcomes among residents of skilled nursing and senior living facilities. Our physicians, nurse practitioners (NPs) and physician assistants ... Help articulate the AlignMed Partners mission to the community and professional organizations Help the center establish appropriate relationships, and coordinate… more
- Prime Therapeutics (Richmond, VA)
- …internal stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with ... Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance Analyst assists in the implementation of Prime's compliance programs,… more