- 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
- 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
- BD (Becton, Dickinson and Company) (Franklin Lakes, NJ)
- …personas, insights, brand positioning statements, benefit ladders, and differentiated claims , to support launches, drive adoption, and accelerate growth across ... and lifecycle management + Lead development and validation of differentiated product claims in collaboration with legal, regulatory, and medical teams to ensure… more
- NYU Rory Meyers College of Nursing (New York, NY)
- …Perform compliance and monitoring assessments to identify exceptions to establish claims adjudication requirements for pre-EOB and after posting of payments. Prepare ... administration.Required Experience:7+ years relevant professional level experience in a claims processing environment.Preferred Experience:Experience working in an Academic Dental… more
- Axtria, Inc. (Berkeley Heights, NJ)
- …management, deep data-driven insights, and seamless management of end-to-end commercial operations . With a global footprint spanning over 30 countries, Axtria is ... governance of patient-level data across multiple systems and sources (eg claims , EMR/EHR, real-world evidence, patient services, digital platforms). You'll ensure… more
- KPH Healthcare Services, Inc. (Syracuse, NY)
- …for developing, improving and continuing the process billing of medical claims for specialty pharmacy facilities. Needs to communicate financial and clinical ... tasks. Establish, manage, and communicate the process of billing medical claims for specialty facilities. **Responsibilities** **Job Duties:** + Manages the existing… more
- Houston Methodist (Houston, TX)
- …responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services. This Specialist is required to perform ... Standards. **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with management to target complex claims and reduce aging of accounts by providing verbal and written… more
- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- …will be a key member of the team tasked with leading best-in-class processes and operations that connect to our culture and values. The Director will lead a small ... 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
- Hatch (Pittsburgh, PA)
- …With expertise insustainable (https://bit.ly/32fZGnV) studies, asset building and operations , and industry-leading efficiencies, our best-in-class team leverages ... to monitor and evaluate contractor progress, performance, schedule delays, and claims . + Review and construction management of TBM and drill-and-blast tunneling… more
- Transdev (Lombard, IL)
- …Responsibilities: + Primary support for key internal topic of insurance and insured claims estimates + Work with actuary and risk department to support valuation of ... significant estimates related to insured claims + Create and maintain pricing model related to...global company, Transdev is a leader in mobility with operations in 19 countries, proudly operated by 110,000 team… more