• Claims Director

    Robert Half Legal (Farmington Hills, MI)
    …A prominent Michigan-based organization in the insurance sector is looking for a dynamic Claims Director . This position is ideal for an experienced leader with ... expertise in claims management, litigation oversight, and operational strategy. *This is...to ensure accuracy and compliance. + Support the executive director and collaborate with leadership on organizational strategy and… more
    Robert Half Legal (08/23/25)
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  • Director of Strategy & Activation

    Henry Ford Health System (Detroit, MI)
    …Under the direction of the Vice President of Planning & Strategy, the Director has primary responsibility for strategic growth assessments, business planning and pro ... clinical delivery system. PRINCIPLE DUTIES AND RESPONSIBILITIES: + Strategic Advisory: The Director will be assigned to select HFH business units as their Strategic… more
    Henry Ford Health System (09/09/25)
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  • Director , Operational Oversight…

    Molina Healthcare (Detroit, MI)
    …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
    Molina Healthcare (07/13/25)
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  • Medical Director

    Molina Healthcare (Detroit, MI)
    …activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
    Molina Healthcare (09/12/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Detroit, MI)
    …activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
    Molina Healthcare (08/08/25)
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  • Voluntary Benefits Director

    WTW (Detroit, MI)
    …management program design, pharmacy solutions, disability/absence management strategies and claims audit services. Product based solutions such as our pharmacy ... purchasing coalition round out our broad-based suite of offerings. **The Role** This role will support our efforts to grow voluntary insurance consulting opportunities in the Midwest region of the US. The position will be a subject matter expert role focused… more
    WTW (09/12/25)
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  • Director , Applications (AI/Azure…

    Molina Healthcare (Detroit, MI)
    …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
    Molina Healthcare (06/29/25)
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  • Regional Human Resources Manager

    Allied Universal (Southfield, MI)
    …This position is responsible for employee relations, employment compliance, unemployment claims , and monitoring of employment status for the employees of that ... and responses to the Department of Labor for unemployment claims . + Participation in employee retention and human capital...to negating a lawsuit. + Support the Regional HR Director and Legal team on sensitive investigations. + Assure… more
    Allied Universal (08/23/25)
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  • Provider Contracts Manager (Skilled Nursing & Care…

    Molina Healthcare (Detroit, MI)
    …for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems ... leadership based on feedback rom assigned MHI attorney. * Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting. * Advises… more
    Molina Healthcare (09/11/25)
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  • Manager, Clinical Data Acquisition (Remote)

    Molina Healthcare (Detroit, MI)
    …matrix, HEDIS work plans, and all product timelines. + Works with the Director to manage contacts within the plan(s) and/or Molina corporate, external auditors, ... software and medical record vendors, and other Molina departments, such as Claims , Enrollment, IT etc,. to get appropriate responses and manage contracts and… more
    Molina Healthcare (08/31/25)
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