- First Student (Cincinnati, OH)
- …legal support for injuries and collisions within the region. Participate on region claims review calls. + Has direct responsibility to ensure proper driving trainer ... staffing levels. Work closely with operations and HR to identify trainer needs and effectively administer driver onboarding. + Other responsibilities as requested or required **Minimum Education or Certifications Required** + College degree preferred; + safety… more
- Dignity Health (Carmichael, CA)
- …reporting process, root cause analyses, investigations and requests from the claims team (including management of subpoenas, Summons and Complaints, and coordination ... of legal documents related to hospital liability). Participates in system office initiatives and programs to mitigate risks in the facility which have been identified at other hospitals, resulting in reduced costs, adverse patient outcomes and ultimately safer… more
- CVS Health (Hartford, CT)
- …settlement processes. + Establish systemic dashboards and KPIs to track membership, claims , rebates, PBM fees, CMS subsidy revenue, risk corridor payments and other ... key financial performance metrics. **Regulatory & Compliance** + Partner with actuarial, compliance, and legal functions to mitigate regulatory and litigation risk. **Actuarial & Pricing Oversight** + Assess and challenge actuarial assumptions, ensuring… more
- Molina Healthcare (Fort Worth, TX)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Fresenius Medical Center (Philadelphia, PA)
- …project specifications and review methodologies. Analyses will include review of claims data, analysis of medication utilization for global contracts and analysis ... of rate structure conversion. + Consolidates patient insurance download data including developing standards for field review of data and reporting. + Provides consolidated business / payer mix / revenue by payer / treatment mix on a monthly basis including… more
- Bristol Myers Squibb (Cambridge, MA)
- …clinical plans and labeling strategy; Appreciates translation of clinical data into claims and considerations for label development. + Understands and contributes to ... development of forecasts and investment scenarios, how to assess risk and conduct valuations, and implications for decision-making. + Contributes to the development of brand hallmarks and brand strategy (generic name, brand name, logo, brand colors,… more
- Centene Corporation (Jefferson City, MO)
- …to providers that would improve utilization and health care quality. + Review claims involving complex, controversial, or unusual or new services in order to ... determine medical necessity and appropriate payment. + May develop alliances with the provider community through the development and implementation of the medical management programs. + As needed, may represent the business unit before various publics both… more
- Sutter Health (Sacramento, CA)
- …advancement and upkeep of the risk financing portfolio for Sutter Health, manages all claims and litigation, and serves as an advisor to senior leadership on risk ... mitigation related to insurance services. Partners with Sutter Health's captive insurance management and board to align strategic risk financing decisions, optimize coverage structures, and ensure governance and oversight of captive operations. Designs and… more
- Fresenius Medical Center (West Chicago, IL)
- …interactive dashboards). + Familiarity with healthcare data (EHR/PM systems, patient flows, claims , outcomes). + Ability to analyze complex data and present insights ... clearly to non-technical audiences. + Strong problem-solving, critical thinking, and attention to detail. + Excellent communication and collaboration skills across technical and non-technical teams. **Education** + Bachelor's degree in Analytics, Data Science,… more
- Marriott (Boston, MA)
- …* Works with the unemployment services provider to respond to unemployment claims . * Attends unemployment hearings and ensures property is properly represented. * ... Ensures employees are treated fairly and equitably. * Ensures Guarantee of Fair Treatment policy is consistently followed and proper documentation is maintained on all disciplinary issues. * Ensures employees are treated fairly and equitably and that issues… more