- 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, ... department regarding the delegated entity reporting requirements to include claims delegation, utilization management delegation and credentialing delegation.8.Respond to… 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
- SSM Health (St. Louis, MO)
- …as a bridge between data-driven insights and business strategy. Analyzes complex datasets to guide data-driven decisions, optimize performance, and achieve ... support strategy and business development initiatives, including third-party vendors, claims data, state data, etc. + Works collaboratively withSystemData Analytics… more
- CRC Insurance Services, Inc. (Phoenix, AZ)
- …with cross-functional teams, including clinicians, underwriters, actuaries, and claims professionals, to develop comprehensive risk management solutions. Contribute ... Excellent communication and presentation skills, with the ability to convey complex concepts to both technical and non-technical audiences. Demonstrated ability to… more
- US Tech Solutions (Chesapeake, VA)
- …of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of ... including co-morbid and multiple diagnoses that impact functionality. + Reviews prior claims to address potential impact on current case management and eligibility.… more