- Manulife (NH)
- …better can take you anywhere you want to go. The Senior Underwriting Consultant is responsible for evaluating applications of the highest financial impact and ... management with book of business reviews. + Review contestable claims for potential misrepresentation during underwriting. + Maintain good...+ Manage all aspects of underwriting process for most complex cases. + Serve as a subject matter expert… more
- Cardinal Health (Hagatna, GU)
- …data from multiple sources (eg, Salesforce, Trella Insights, Definitive Healthcare, claims feeds, internal CRM/ERP) to deliver clear, actionable insights that ... gaps + Ensure HIPAA/privacy safeguards and appropriate minimum necessary use of PHI/ claims . + Define and operationalize Reach (# of targeted HCPs/accounts touched)… more
- CVS Health (Columbus, OH)
- …professional with strong coding skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste, and abuse (FWA) ... manipulate, and analyze large healthcare datasets. + Design, develop, and maintain complex data analyses to support investigations of potential fraud, waste, and… more
- Travelers Insurance Company (Overland Park, KS)
- …inspections on all accounts. Under close supervision, performs risk evaluations and claims investigations on less complex accounts as assigned. Participates in ... adequacy of controls preventing equipment breakdown, and overall insurability. Investigate less complex Equipment Breakdown claims as requested by the claim… more
- Turner & Townsend (Houston, TX)
- …cost planning, estimating, and commercial activities across project phases on large scale/ complex projects. + Develop and maintain cost plans from concept through ... and client expectations. + Manage post-contract processes including change control, claims evaluation, and final account settlements. + Prepare clear, commercially… more
- WellSense (MA)
- …liaison between provider and internal Plan departments such as Provider Enrollment, Claims , Audit, Marketing, Customer Care and Care Management. **Our Investment in ... visit servicing standards** + **Acts as liaison for all reimbursement, credentialing, claims , EDI web site procedures and issues of key providers** + **Facilitates… more
- Elevance Health (Tampa, FL)
- …Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider ... process. Works with multiple provider types including the most complex , high profile providers. Supports a full range of...of contract arrangements and pricing mechanisms including the most complex contract terms. Works on the most complex… more
- Guidehouse (Chicago, IL)
- …in data modeling, design, and analytic techniques leveraging large or complex data sets, eg, ETL process design and administration, within common ... Power BI, Tableau, TIBCO Spotfire or others + Strong understanding of healthcare claims (facility or payer) data and/or HIT applications including those used to… more
- Highmark Health (Harrisburg, PA)
- …members to capture capability needs and drive quality business solutions on complex issues. Create and maintain deliverables such as business vision, requirements, ... subject matter expertise for both project and production related activities on complex issues, including new strategic programs or initiatives impacting current and… more
- Health Care Service Corporation (Chicago, IL)
- …Of Physicians, Physician Groups And Facilities Including Large Or Complex Groups/Facilities (Large Independent Hospital Systems, Integrated & Non-Integrated Systems, ... *Extensive knowledge of provider and facility contracting, products, and claims /processing systems. *Negotiation skills. *Relationship building skills. *Knowledge of… more