- Prime Therapeutics (Lansing, MI)
- …Responsibilities Oversee one or more strategic initiatives in partnership with Operations and/or IT Collaborate with all levels of cross-functional stakeholders and ... tools, platforms and products Experience using queries, thorough understanding of pharmaceutical claims data and general understanding of medical claims data;… more
- Prime Therapeutics (Raleigh, NC)
- …Principal is responsible for supporting the business in decision making and operations efforts by providing data, reporting and business intelligence services. This ... experience, preferably leveraging AI PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data Experience in the… more
- Prime Therapeutics (Lansing, MI)
- …disruption. Responsibilities Oversee one strategic initiative in partnership with Operations and/or IT Collaborate with cross-functional stakeholders to advance ... tools, platforms and products Experience using queries, thorough understanding of pharmaceutical claims data and general understanding of medical claims data;… more
- Evolent (Oklahoma City, OK)
- …Doing: Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to identify cost drivers, utilization ... degree, preferably with a quantitative major (eg actuarial, statistics, operations research, mathematics, economics) or healthcare focus (health administration,… more
- Utilities Service, LLC (Medina, OH)
- …- (DL Required) This position ensures the productivity of daily operations , working closely with management to determine recruiting/hiring needs, deadlines, and ... be delegated the authority to investigate incident reports, damage claims , etc., and to settle minor damage claims... claims , etc., and to settle minor damage claims . Maintains accurate records, timesheets, and reports related to… more
- Allied Universal (Phoenix, AZ)
- Company Overview Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation ... fuel and travel expenses RESPONSIBILITIES: Conduct independent investigations of insurance claims across a range of coverage types, including workers' compensation,… more
- Zurich NA (Boston, MA)
- …Diploma or Equivalent and 14 or more years of experience in the Claims or Underwriting Support areaOR Zurich Certified Insurance Apprentice including an Associate ... an Associate Degree and 12 or more years of experience in the Claims or Underwriting Support area Knowledge of Casualty product lines and insurance industry… more
- Humana (Dayton, OH)
- …work closely with internal and external auditors, financial investigators, and claims processing areas Adequately staff and manage the program integrity ... Clinical Certifications, CPC, CCS, CFE, AHFI) Understanding of healthcare industry, claims processing and investigative process development Experience in a corporate… more
- Ally (Raleigh, NC)
- …of in-depth background in bank fraud investigations of all types of forgery claims and schemes (ie, kite schemes, counterfeit checks, forgeries, wires, ach, etc.), ... banking operations , government regulations, basic knowledge of UCC codes and...knowledge of UCC codes and industry defenses to adverse claims . CFE, CAFP, and CFCI certifications preferred. Knowledge in… more
- US Tech Solutions (Monroeville, PA)
- …Billing Specialist I will be responsible for qualifying, preparing and submitting claims to Medicare Part B, Major Medical and Medicaid. Individual must work ... with LTC facility staff, Omnicare pharmacy operations staff, prescriber offices, third party payers, patients and/or...collect supporting or additional information on fills and work claims through to resolution to ensure compliant, timely and… more
