- Merck & Co. (Boston, MA)
- …are seeking a highly skilled and motivated Associate Principal Scientist/Associate Director with expertise in conducting outcome researching using real world data, ... patient level healthcare data, including but not limited to administrative claims , EHR/EMR, disease registry, and public-use databases. Develop machine learning… more
- Eisai, Inc (Boston, MA)
- …internal cross functional partners including but not limited to Associate Director Regional Marketing, Oncology Field Reimbursement Managers, and other specialty ... (eg, PhRMA Code; Federal Food, Drug, Cosmetic Act; Anti-Kickback Statute; False Claims Act, OIG/DOJ Guidance; Foreign Corrupt Practices Act; and federal and state… more
- Lincoln Financial (Boston, MA)
- …#:** 74680 **The Role at a Glance** We are excited to bring on a highly motivated Claims Director to our Claims Organization! * As a Claims ... manage will oversee and ensure the fair, ethical and timely management of complex claims for your assigned area(s) of responsibility. You will also be directing and… more
- Citizens (Westwood, MA)
- …career with exciting new challenges and opportunities to stretch yourself. As the Director of First Line Risk, you will represent the first line of defense ... of Risk Managers and/or Senior Risk Managers primarily supporting the Fraud and Claims line of business Qualifications: + 8-12+ years experience in Risk Management,… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims Job Description **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr. Analyst plays ... of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the… more
- Humana (Boston, MA)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Boston, MA)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Boston, MA)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Commonwealth Care Alliance (Boston, MA)
- …for One Year Term **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims ... Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims Position Summary: Reporting to the Director , Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. Specialist II is ... Medicaid) and CMS Medicare requirements. This role is housed within the Claims Operations & Quality Assurance team and works closely with Cognizant (TPA)… more
