- Highmark Health (Des Moines, IA)
- …**Substitutions** + 6 years of Dental Solutions Application Portfolio (eg, Concordia Claims Processing & RENO, Portal applications, UCD billing, etc.) experience may ... be substituted for the Bachelor's degree (in addition to other required experience) **Preferred** + None **EXPERIENCE** **Required** + 5 - 7 years of experience in Information Technology + Must be a US Citizen **Preferred** + Problem solving, root cause… more
- Fluor (Greenville, SC)
- …contractors' productivity, schedule adherence, contract change management, invoicing and claims avoidance * Perform closeout of contracts, finalize outstanding ... contract issues, issue of final modifications, invoices and coordinate completion of contractor performance evaluations * Other duties as assigned **Basic Job Requirements** * Accredited four (4) year degree or global equivalent in applicable field of study… more
- World Insurance Associates, LLC. (Tilton, NH)
- …excellent service, and professional communication + Handling renewals, service requests, claims , billing and new policies + Maintain a thorough understanding of ... the markets and their appetites, underwriting guidelines, submitting and procedures + Review all applications, policies, endorsements and audits for accuracy + Complete loss/claim analysis and summaries + Coordinate expiration list with department manager to… more
- UPMC (Dubois, PA)
- …as the primary contact for assigned providers, offering guidance on claims , authorizations, credentialing, and contracting. + Build strong relationships through ... regular outreach, meetings, and follow-ups. + Educate providers on Community Care policies, procedures, and product differences. + Coordinate service schedules and ensure consistent phone coverage with your team. + Maintain accurate documentation of provider… more
- World Insurance Associates, LLC. (Miami, FL)
- …excellent service, and professional communication + Handling renewals, service requests, claims , billing and new policies + Maintain a thorough understanding of ... the markets and their appetites, underwriting guidelines, submitting and procedures + Review all applications, policies, endorsements and audits for accuracy + Coordinate expiration list with department manager to obtain renewal business information… more
- NCR VOYIX (Atlanta, GA)
- …commercial contract, employment, competition-related, environmental and intellectual property liability claims and lawsuits, from inception to trial and appeal or ... settlement, and collaborates with outside counsel on case strategies and budget management. The successful candidate must be able to identify and lead litigation strategies, and when called upon, advocate for and represent the company in such matters. The… more
- CVS Health (Hartford, CT)
- …test plans and test results + 3+ years of HRP experience + Claims adjudication background + Knowledge of MedCompass and Utilization Management Configuration. + ... Knowledge of Medicare Advantage and/or IFP products, claim policies and procedures. + Experience interpreting business requirements to identify claim adjudication impacts and test scope. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The… more
- Leonardo DRS, Inc. (Johnstown, PA)
- …professional relationships with suppliers. Resolve issues (eg pricing, quality, timing, claims , contract disputes, etc.) associated with terms and conditions of ... service agreements + Understand demand/spend profile for commodity areas, and provide this information as necessary + Track and report cost savings or avoidances + Maintain current accurate records and files of all vendor agreements and related procurement… more
- Molina Healthcare (Yonkers, NY)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. **KNOWLEDGE/SKILLS/ABILITIES** + Develop ad-hoc reports using SQL programming, SQL Server… more
- MetLife (Cary, NC)
- …Key Responsibilities * Date science in Dental: Contributions to underwriting models, claims auto-adjudication logic and models, fraud waste and abuse analyses and ... models (mostly provider-related), dental network analyses, consumer analytics, network expansion analytics and much more. * Leads and contributes to data analysis and modeling projects from project/sample design, business review meetings with internal and… more