- Humana (Honolulu, HI)
- … first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse ... teams focusing on quality management, utilization management, discharge planning and/or home health or rehab + Must be passionate about contributing to an… more
- Novant Health (Winston Salem, NC)
- …ten years health care experience with five years professional liability claims experience, required. + Medical malpractice claims experience., required. + ... What We Offer The Claims Manager is responsible for analyzing, negotiating and...Graduate Degree, preferred. JD, MBA, MS in Nursing Allied Health or MHA preferred. + Experience: + Minimum of… more
- AbbVie (North Chicago, IL)
- …well as real-world evidence generation using state-of-the-art in-house data sources, such as health records, claims and registry data. As an Epidemiology Intern, ... is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to… more
- CareFirst (Baltimore, MD)
- …technology support, Utilization Management (UM) operations, Clinical Product Configuration, Health Plan Claims /Authorization workflows, or related healthcare ... projects as needed. Maintain a strong working knowledge of the FACETS claims -to-authorization matching workflow and utilize this knowledge to identify and resolve… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …* Bachelor's degree Master's degree. * Knowledge of managed care and health care claims preferred. * Experience with Databricks preferred. Compensation ... of focus in the department include but are not limited to provider, health management, quality, product development and client/member analytics. A typical day for… more
- Banner Health (Phoenix, AZ)
- …Shift:** Day **Job Category:** Risk, Quality and Safety Great careers are built at Banner Health . There's more to health care than doctors and nurses. We support ... this could be the perfect opportunity for you. Banner Health is seeking a Senior Risk & Insurance Analyst...department and assist with risk identification, mitigation, transfer, and claims management to protect one of the nation's largest… more
- Dragonfly Health (Mesa, AZ)
- …supervisor or manager._ 1. Assist pharmacies with real-time and retrospective claims adjudication. Adjust and correct authorizations in dispensing and PBM systems ... to ensure timely claims submission. Research and resolve rejected claims by contacting hospices for approvals or updated authorizations. 2. Maintain accuracy of… more
- MVP Health Care (Schenectady, NY)
- At MVP Health Care, we're on a mission to create...continuous improvement. To achieve this, we're looking for a Claims Examiner to join #TeamMVP. If you have a ... passion for medical claims and attention to detail this is the opportunity...well-being + An opportunity to shape the future of health care by joining a team recognized as a… more
- Catholic Health Services (Melville, NY)
- … Analyst is responsible for monitoring, analyzing, and reporting on professional liability claims and legal expenses for the health system. This role supports ... Overview Catholic Health is one of Long Island's finest ...Risk Management team by maintaining oversight of active litigated claims , reconciling financial data provided by third-party administrators (TPAs),… more
- CVS Health (Franklin, TN)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...with heart, each and every day. **Position Summary** The Claims Administrator is responsible for routing claims … more