• Senior Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …clinical practice of medicine. + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons License - Medical Board of CA ... Time** **Shift End Time** Doctor of Medicine (MD); California Physicians and Surgeons License - Medical Board of CA; Doctor of Osteopathic Medicine (DO) **Hours**… more
    Sharp HealthCare (07/19/25)
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  • Work Comp Complex Claim Director

    AIG (Atlanta, GA)
    Make your mark in Complex Claims . The AIG Workers' Compensation (WC) Major Case Unit (MCU) is a group of well trained and highly dedicated claim professionals ... with an average of 26 years WC claim handling experience. We take a collaborative approach in...a collaborative approach in handling large, complex, and catastrophic claims . Team members excel from sharing each other's strengths… more
    AIG (06/06/25)
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  • Corporate Counsel - Claim Director

    Robert Half Legal (York, PA)
    …clients in navigating complex issues. * Oversee and manage a team of Insurance Claim Managers to ensure effective handling of claims processes. * Provide expert ... and major insurance carriers to facilitate prompt and effective claim resolutions. * Address intricate insurance claims ...actionable solutions. * Juris Doctor (JD) degree and active license to practice law. * Familiarity with claims more
    Robert Half Legal (07/04/25)
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  • Complex Claims Director , General…

    AIG (Atlanta, GA)
    …reimagining the way we help customers to manage risk. Join us as a Complex Claims Director , General and Auto Liability to play your part in that transformation. ... efficiency. How you will create an impact The Complex Director is Senior Adjuster role in Primary Claims...and gathering information to determine the exposure on the claim ; ensure proactive claims handling aimed at… more
    AIG (07/15/25)
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  • Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …as a physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical Board of CA ... Start Time** **Shift End Time** California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine...management such as provider relations, member services, benefits and claims management, etc. Assists (as determined by the plan… more
    Sharp HealthCare (05/18/25)
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  • Director , Claims Modernization,…

    Healthfirst (NY)
    …+ Assists in the development of strategic plans to ensure modern and efficient claims processing across the entire lifecycle with a focus on a unified, streamlined ... leadership to support the evolution and operation of a variety of digital claims capabilities on our modernization roadmap + Analyzes project needs and determines… more
    Healthfirst (07/04/25)
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  • Medical Director - New Jersey Market

    CVS Health (Dover, DE)
    …have a NJ License without encumbrances or the ability to obtain a NJ License . In the Medical Director role you will provide oversight for medical policy ... timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance… more
    CVS Health (07/10/25)
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  • Sr Claims Supervisor - Work From Home

    HCA Healthcare (Nashville, TN)
    …in territory assigned. + Oversight and administration of special projects as assigned by the Claims Director , HCI President and VP of Claims . + Have strong ... the larger Risk & Insurance Department reporting to a Director of Claims . As the Senior ...as the Company representatives with authority to resolve the claim . + Maintain current licensure needed to perform duties… more
    HCA Healthcare (06/21/25)
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  • Medicare/Medicaid Claims Editing Specialist

    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 ... claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic and policies… more
    Commonwealth Care Alliance (05/28/25)
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  • Medicare/Medicaid Claims Reimbursement…

    Commonwealth Care Alliance (Boston, MA)
    …states will not be considered at this time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr. ... the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible… more
    Commonwealth Care Alliance (05/31/25)
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