- AbbVie (North Chicago, IL)
- …trials that make use of real-world databases, eg electronic health records, insurance claims databases, and/or registries. + Play a key role in the cross-functional ... team and ensure that study results and conclusions are scientifically sound, clearly presented, and consistent with the statistical analyses provided. Ensure timely and quality statistical deliverables. Assist other MA&HTA Statistics colleagues or represent… more
- Genentech (South San Francisco, CA)
- …clinical workflows + Expertise in managing and applying healthcare data (RWD, RWE, claims , EHR). + Strong knowledge of AI/ML for insights and process automation, ... along with familiarity with digital health technology (CRM) and data privacy regulations (HIPAA) **Preferred Qualifications & Experience** + A medical degree or prior experience in Medical Affairs is a strong plus. **Location & Travel Requirements** This… more
- Commonwealth Care Alliance (Boston, MA)
- …management functions with network strategy, vendor relationship management and claims processing. Works closely with provider relations on resolving provider ... related issues. * Directs the work of the utilization management team to ensure quality, interrater reliability and standards are met in daily operations. Responsible for resolution and communication of utilization management issues and concerns and corrective… more
- BeOne Medicines (San Mateo, CA)
- …competing trials, recent or upcoming approvals, prescribing data, insurance claims data, diversity, and recruitment capabilities. This includes intelligence ... gathering and risk assessment with therapeutic knowledge balanced with data analytics and interpretation. The Global Strategic Feasibility Analytics Lead supports the Head of Global Strategic Feasibility to improve the Global Strategic Feasibility processes,… more
- Lilly (Indianapolis, IN)
- …requirements; the Anti-kickback Statute and its safe harbors; the False Claims Act; antitrust; unfair competition law; consumer protection; data rights and ... privacy; FTC commercial law; and business transactions + Substantial experience counseling biotechnology or pharmaceutical organizations on genetic medicine-specific legal challenges, including global regulatory submissions, manufacturing and distribution… more
- NCR VOYIX (Atlanta, GA)
- …and work with internal departments to resolve all outstanding Accounts Receivable claims + Manage information requests during audits and respond to requests for ... information during internal audits + Document trends and initiate corrective action to ensure maximum cash reimbursement, prompt payment for services rendered and uninterrupted cash flow + Monitor and provide constructive feedback on team performance to ensure… more
- The Cigna Group (Morris Plains, NJ)
- …to Have** + Prior **PBM/specialty pharmacy** platform knowledge (eg, claims /benefit management, care coordination, specialty workflows). + Earlier **hands‑on ... engineering** (software, data, or platform) before moving into architecture leadership. + Industry credentials (eg, **TOGAF** , Azure/AWS architecture) and/or published architecture patterns. **Leadership Competencies** + Strategic Mindset, Drives Results,… more
- AdventHealth (Ormond Beach, FL)
- …safety, and learning systems. + Identifies and reports occurrences with potential claims to the Director of Risk Management per established protocol. ... contribute:** The Patient Safety Coordinator (PSC) under the direction of the Director of Risk Management is responsible for implementation and coordination of… more
- NYU Rory Meyers College of Nursing (New York, NY)
- …discrepancies by payers. Contact payer to resolve appeals and final solution to claims . Collaborate with the Director of Insurance Strategy in developing, ... Position Summary Manage claims adjudication by identifying contractual variances between posted...providing guidance and direction relating to the performance of claims adjudication process. Train staff and administrators to support… more
- Sedgwick (Austin, TX)
- …department or special projects as assigned by the Finance Manager or Director . + Process account collections/receivables. + Reconcile claims activity between ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more