- Lincoln Financial Group (Providence, RI)
- …**Requisition #:** 72954 **The Role at a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence team supporting ... Group Protection in a remote environment. Background Details The Claimant Excellence Team will...development to perform in this fast-paced environment. As a Claims Customer Care Associate , you… more
- Humana (Providence, RI)
- …to drive improvements in quality and/or reductions in total cost of care + Scorecard creation and reconciliation of provider performance based on contractual ... Qualifications:** + Bachelor's Degree + 3-5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care +… more
- Marriott (Providence, RI)
- …as injured worker advocate assisting them to set goals and participate in their care . + Recommend referral to Associate Resource Line as needed. + Coordinate ... **Additional Information** Nurse CARE Manager ( CARE - Coordinated Action...jurisdiction. This position is responsive to Marriott's associates, Marriott Claims Services, business units, Risk Management and community health… more
- BrightSpring Health Services (Taunton, MA)
- …PharMerica Overview Our Point of Sale Adjudicators are crucial to our 3rd Part Claims activities and our business. This is an excellent opportunity to move from a ... pharmacy to office environment for those who are willing to learn claims , billing and insurance processing. Pharmacy Technician experience and/or knowledge of… more
- Humana (Providence, RI)
- …Clinical Strategy and Analytics (CS&A) Team is seeking a Research Scientist 2 ( Remote ). Healthcare is rapidly changing, and our members are living longer, often with ... clinical concepts and extract clinical information from medical, pharmacy, and lab claims for analytics and modeling purposes + Translates analytic results into key… more
- Humana (Providence, RI)
- …responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Humana (Providence, RI)
- …more years of experience with CMS and/or AHCA compliance + 2 or more years Claims experience + 2 or more years Audit and/or Financial Recovery experience + SQL ... structure and design **Preferred Qualifications** + Direct experience working with Medicare claims + Working knowledge of CPT, ICD10 and HCPC + Provider contract… more
- Humana (Providence, RI)
- …first** Humana's Clinical Analytics Team is seeking a Senior Research Scientist ( Remote ). Our team identifies opportunities and builds solutions to improve clinical ... improvement for our members. + Develop models and/or rules using clinical condition in claims data, membership data, or other data sources in order to target at-risk… more
- Humana (Providence, RI)
- …team reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The Medical ... depth of knowledge of administrative processes and organizational knowledge. **This is a remote position from anywhere in the US.** **What Humana Offers** We are… more
- Humana (Providence, RI)
- …Disputes reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The ... **What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company...opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent… more