- Molina Healthcare (Des Moines, IA)
- …Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from ... processed in accordance with local Health Plan requirements * Works with Claims , Configuration, Contracting, Provider Data Management, and other business partners to… more
- Elevance Health (Richmond, VA)
- **Clinical Documentation and Claims Integrity Director ** **Location:** Alternate locations may be considered. This position will work a hybrid model ( remote ... home-care and community based services. The **Clinical Document Improvement Director ** is responsible for leading encounter processing, diagnostic documentation and… more
- Centene Corporation (Austin, TX)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Director , Workforce Management serves as a business leader who will be ... and owning workforce management strategy, process, and execution for claims . Will focus on tactical and strategic plans, capacity...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- NTT DATA North America (Decatur, IL)
- …Rate $22-$23/hr **Position Summary:** The Utilization Management Coordinator reports to the Director of Claims . This position is responsible for coordinating the ... currently seeks a Utilization Management Coordinator to join our team for a remote position. 100% Remote , Client provides equipment Temporary Role - Duration… more
- Sharp HealthCare (San Diego, CA)
- …and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp Health Plan's (SHP) ... practice of medicine. + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons License - Medical Board of CA -REQUIRED… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this ... time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims ... 011250 CCA- Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will… more
- Access Dubuque (Dubuque, IA)
- …Cottingham & Butler/ SISCO Sales Executive - Casualty Claims (Fully Remote ) Cottingham & Butler/ SISCO Safety Director Specialized Recruiting Group SPORTS ... Claims & Safety Captive Consultant **Cottingham & Butler/...ID: 4052348008 Posted On 08/05/2025 **Job Overview** **Safety & Claims Consultant - P&C Captives** **Position Summary:** We are… more
- BJs Wholesale Club (Marlborough, MA)
- …counsel and TPA. + Identifies claim trends and provides recommendations to the Claims Manager and Director , Risk Management, and Insurance for decreasing the ... members receive the best possible care, provides oversight of third party claims administrator (TPA) to achieve optimal financial results; partnering with clubs/DC's… more
- Molina Healthcare (Albany, NY)
- …by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and controls that ... you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners… more