- HCA Healthcare (Henderson, NV)
- …coding. + Report and manage IET's and Claims on Hold, Encounters without Claims in conjunction with Practice management . + Regularly review A/R data and ... together with Provider Enrollment, Coding Education, Payor Contracting and Analytics, Transition Management , Accounts Receivable Management , as well as with the… more
- BlueCross BlueShield of North Carolina (NC)
- … payment integrity program. Serve as liaison with other key departments (Medical Management , Network Management , Data Analytics, Claims & Enrollment ... monitor, and update respective roles, responsibilities, and strategies related to claims payment integrity activities. **Fraud Detection and Prevention:** + Work… more
- BronxCare Health System (Bronx, NY)
- …participation include data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in ... Educator delivers comprehensive services to bridge the gap between clinical and self- management aspects of diabetes and disease prevention for those patients with… more
- BronxCare Health System (Bronx, NY)
- …participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in ... resources, and adopt healthy behaviors. The CHW supports providers and the Care Management Coordinator through an integrated approach to care management and… more
- C&W Services (New York, NY)
- …audits, report and manage the corrective actions + Support Workers Compensation (WC) claims tracking, investigation, and management process + Liaise with WC ... minimized and corrected. Coordinate with Regional Engineering Leaders and site management on deficiencies and monthly safety inspections + Maintain all logs… more
- Burns & McDonnell (Atlanta, GA)
- …including recruiting, prequalifying and selecting Subcontractors. + Manage subcontractor change management and claims mitigation process. + Manage Prime ... of Aviation type projects. Initial responsibilities will involve day-to-day management of multi-discipline design and/or design-build projects, including developing… more
- LA Care Health Plan (Los Angeles, CA)
- Director, Configuration Job Category: Management /Executive Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017 Position Type: Full ... and other operational departments to ensure configuration supports a high-performing claims environment with strong control points, reduced rework, and timely,… more
- Sacramento County (Sacramento, CA)
- …these items during the interview process to determine your proficiency. + Claims software (eg NavRiskClaims/Ventiv). + Document management software (eg OnBase). ... Type Permanent Full-Time Job Number 28553-D Department Personnel Services Division Risk Management Opening Date 12/18/2025 Closing Date 1/29/2026 5:00 PM Pacific +… more
- CareFirst (Baltimore, MD)
- …Skills and Abilities (KSAs)** + Strong knowledge of PBM contracting, claims adjudication, pharmacy network management , formulary design, financial processes ... for leading critical financial and analytic functions within the Pharmacy Management department. This role ensures the organization maximizes contractual value by… more
- Guardian Life (New York, NY)
- …candidate will bring deep expertise in Policy Administration, Actuarial, Reinsurance and Claims functions + Strong general management mindset and broad ... processes impacting product success + Partner with business leaders and change management teams to define product business value, support messaging and customer… more
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