- Prime Healthcare (Ontario, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/176331/vp-of-health-plan- operations -and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... to improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee...(7) to ten (10) years prior work experience in Claims Operations and Health Plan Strategy, in… more
- AIG (Jersey City, NJ)
- Claims Complex Director - Healthcare Professional...an exciting time to join us - across our operations , we are thinking in new and innovative ways ... create an impact + This position will ensure high quality claims handling within the Healthcare Professional Liability ("HPL") Claims Department of General… more
- The Cigna Group (Bloomfield, CT)
- … experience, including a minimum of 5 years' experience in ACA Claim Operations and/or Payment Integrity functions, such as claims editing, claim coding, ... The Claims Strategy and Payment Integrity Senior Manager will...savings initiatives, monitoring and driving improvements in overall claim operations performance , and will assist in defining the… more
- Commonwealth Care Alliance (Boston, MA)
- …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...on financial ability and forecasting for small to large Operations Management + Collaborate system and data configuration into… more
- Molina Healthcare (MI)
- …to increase the quality and efficiency of claims processing + Fields claims questions from Molina Operations teams + Interprets, communicates, and presents, ... impacted claims + Provides excellent customer services to our internal operations teams concerning claims projects + Appropriately convey information and… more
- Molina Healthcare (NY)
- …clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains ... unresolved errors issued on daily transactional audits and communicates with Core Operations Functional Business Partners to ensure resolution within 30 days of… more
- Elevance Health (Columbus, OH)
- **Staff VP Claims Operations (Original Claims )** **Location:** Successful candidate must reside within 50 miles of an Elevance office, and able to work a ... solutions + Experience having accountability for performance of large-scale claims operations + Experience managing large teams...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Healthsource blog: https://healthsource.premera.com . We are seeking an experienced and dynamic ** Claims Operations Director** to join our team and oversee our ... claims management organization. This position offers an exceptional opportunity...strategic direction, business planning, and overall leadership for Premera's healthcare payer operations across various customer segments… more
- Molina Healthcare (UT)
- …Interfaces with the customer in developing requirements for major complex claims testing projects within Medicare, Medicaid and Marketplace; prepares system test ... to fully test reported issues/requirements . * Fields direct questions from Molina Operations Staff regarding business, technical and operations rules that may… more
- Banner Health (Phoenix, AZ)
- …with healthcare risk management, quality management, in house liability claims management (including litigation and claims reserves) and litigation** ... claims management processes and procedures and other related healthcare regulatory and/or litigation experience preferred. Additional related education and/or… more
- Veterans Affairs, Veterans Health Administration (Denver, CO)
- …the position is initial evaluation and processing of beneficiary submitted healthcare claims for payment. Responsibilities PRINCIPAL DUTIES AND RESPONSIBILITIES: ... to analyze and resolve issues involving claim submission utilizing automated healthcare claims processing systems, methods, procedures, and techniques. GS-07… more
- LA Care Health Plan (Los Angeles, CA)
- …to achieve that purpose. Job Summary The Claims Supervisor works with the Claims Manager to oversee the daily operations of the claims department. ... Supervisor, Claims Job Category: Claims Department: ...Duties Continued Education Required Bachelor's Degree in Business or Healthcare Related Field In lieu of degree, equivalent education… more
- AIG (Chicago, IL)
- …an impact + This position will ensure high quality claim handling in the Healthcare Professional Liability ("HPL") Claims Department of General Insurance (AIG, ... Senior Claims Analyst, Severity Join us as a Senior...The analyst will investigate losses, orchestrate defense strategies for healthcare provider insureds, conduct independent assessments as to exposures… more
- Zelis (Atlanta, GA)
- …responsibilities as assigned Education Bachelor's Degree preferred Skills 3-5 years of claims experience in a healthcare environment Zelis is modernizing the ... The Regulated Claims Settlement Coordinator supports the Claims ...the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers,… more
- Providence (NM)
- …statements for services and take proper steps to pay vendors + Inform Senior Manager Operations of large or complex claims and claims with potential for ... empower them.** **Providence is calling a Sr. Professional Liability Medical Claims Manager who will:** **Investigate, Evaluate, and Manage Professional, General and… more
- Access Dubuque (Dubuque, IA)
- Claims Processing Representative **Grand River Medical Group** 1 Positions ID: 1343279 Posted On 10/30/2024 **Job Overview** ** Claims Processing Representative** ... available Grand River Medical Group is seeking an experienced Claims Processing Representative to join our Revenue Cycle Team....in Dubuque, IA. We provide a wide range of healthcare services from primary care to subspecialty care for… more
- Humana (Columbus, OH)
- …our caring community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures accuracy for ... point of sale transition adjudicated claims logic. The Senior Pharmacy Claims Operations Professional work assignments involve moderately complex to complex… more
- Guidehouse (San Antonio, TX)
- …in Lieu of Diploma / GED. + 0-2+ year's experience in office, business, operations , customer service or healthcare field. **What Would Be Nice To Have** ... **:** + Knowledge and utilization of desktop applications to include Word and Excel is essential for job responsibilities. + Ability to initiate and follow through on projects and work independently with minimal supervision. + For insurance specific clients:… more
- Humana (Tampa, FL)
- …us put health first** The Claims Research & Resolution Representative 2 manages claims operations that involve investigation of claims for and against ... support duties that require independent initiative and judgment. Tampa Office The Claims Research & Resolution Representative 2 + Works with ancillary departments,… more
- Molina Healthcare (IA)
- …with multiple types of business data. May be internal operations -focused or external client-focused. **KNOWLEDGE/SKILLS/ABILITIES** + Provides analytical, problem ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
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