- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and integrity of ... methodologies, risk score calculations, enrollment, submissions, medical and pharmacy claims , and provider data. Incumbent is responsible for performing analyses… more
- Otsuka America Pharmaceutical Inc. (Boston, MA)
- …organization. + Recommends and administers policies and procedures to enhance business operations and sales analytics. + Demonstrated deep understanding of IDN, MHC, ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Sysco (Vernon, CA)
- …governmental specifications. Utilize email and electronic monitoring system to submit claims to suppliers on products not meeting product specifications. Follow up ... with suppliers on claims . Work closely with FSQA, Merchandising and/or Accounting Department to insure claims are paid. Assist in Employee Training of FSQA… more
- MyFlorida (Miami, FL)
- …POSSIBLE MULTI-HIRE OPPORTUNITY THIS IS AN OPS POSITION TITLE: OPS CLAIMS ADJUSTERS, EXAMINERS AND INVESTIGATORS MEDICAL DISABILITY EXAMINER POSITION LOCATION: ... Social Security Disability Insurance, Supplemental Security Income and/or Medically Needy disability claims filed in the State of Florida. Training is provided on… more
- Molina Healthcare (Cleveland, OH)
- …care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of health care financial terms (eg, ... decision-making. * Mines and manages information from large data sources. * Analyzes claims and other data sources to identify early signs of trends or other… more
- Molina Healthcare (Pensacola, FL)
- …least 3 years of health care experience, to include experience in claims , provider services, provider network operations , and/or hospital/physician billing, or ... and timely validation and maintenance of critical provider information on all claims and provider databases, and ensures adherence to business and system… more
- UIC Government Services and the Bowhead Family of Companies (Anchorage, AK)
- …an understanding of the NEPA process. + General understanding of the Alaska Native Claims Settlement Act and landownership in the State. + Essential to this role are ... characteristics EOE/AA/M/F/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq.,...our Inupiat shareholders. The size and diversity of our operations means we have a broad variety of career… more
- Humana (Oklahoma City, OK)
- …investigations into allegations of fraud, waste, and abuse involving providers who submit claims to Humana's Oklahoma Medicaid line of business. As the Senior Fraud ... outcomes; work closely with internal and external auditors, financial investigators, and claims processing areas + Assist in developing FWA education to train staff,… more
- Walmart (Plainfield, IN)
- …promotion coaching teaching and evaluation of associates and leaders Facilitate carrier operations by processing and monitoring carrier claims working with ... carriers and home office on resolution of claims scheduling carrier unloads and resolving concerns and maximizing benefits to the operation of the facility and… more
- Wells Fargo (Charlotte, NC)
- …distressed trades on credit products such as loans, bonds, reorganized equity, and claims . The ideal candidate will have a proven track record of managing ... and distressed trades on credit products including loans, bonds, reorganized equity, and claims . + Successfully monitor the flow of trades from trade date to settle… more