- Merck & Co. (North Wales, PA)
- Job DescriptionResponsibilities:Utilize big data to analyze the safety and efficacy claims of potential medical breakthroughs. Review the quality and ... reliability of clinical studies using deep scientific knowledge, statistical analysis and high-quality data to support decision making in clinical trials.Support statistical programming activities for Early Oncology clinical development projects.Responsible… more
- Merck & Co. (North Wales, PA)
- …to the Director/Senior Director in the Office of Promotion and Advertising Review (OPAR)The Associate Director is responsible for the review and ... and serving as the promotional regulatory expert with marketing, legal, and medical teams to ensure that promotional practices are consistent with regulatory… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... the Oncology Business Unit/US Oncology Business Division (including, for example, Medical Affairs, Sales, Marketing, Market Access, etc.) including, but not limited… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... Labeling and Pricing Committees and as legal representative on the promotional materials review team for market access team and materials (including, but not limited… more
- Eisai, Inc (San Diego, CA)
- At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care ... oral markets with approved indications, helping targeted customers, such as Medical Oncologists, Hematologists, Endocrinologists, and nurses, etc. learn about the… more
- Eisai, Inc (Fort Worth, TX)
- At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care ... oral markets with approved indications, helping targeted customers, such as Medical Oncologists, Hematologists, Endocrinologists, and nurses, etc. learn about the… more
- Robert Half Accountemps (Los Angeles, CA)
- Description We are offering a contract to permanent employment opportunity for a Medical Claims Review Coordinator in Los Angeles, California. The individual ... examiners to use in evaluating whether certain types of claims may require review . * Work collaboratively...Provide guidance to Participant Services Representatives on calls regarding medical claims issues. * Recommend changes to… more
- Molina Healthcare (Lexington, KY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... Claims Auditing, Medical Necessity Review and Coding experience + Familiar with state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:**… more
- ManpowerGroup (Columbia, SC)
- …compliance and ensure ongoing process improvement. **Qualifications:** + Strong understanding of medical claims review processes, medical necessity ... **Job Title: Medical Claims Reviewer** **Pay Rate:23/Hr (REMOTE...Ensure thorough documentation of each determination for utilization or claims review . + Review first-level… more
- US Tech Solutions (Columbia, SC)
- …claims and utilization practices. + May provide any of the following in support of medical claims review and utilization review practices: Performs ... medical necessity guidelines. Utilizes allocated resources to back up review determination. Reviews interdepartmental requests and medical information in a… more
- Commonwealth of Pennsylvania (PA)
- …You will be responsible for notifying relevant parties of DHS interest, initiating request of medical claims for review , and following up to ensure payment ... As a Third Party Liability Program Investigator, you will review documents from attorneys and insurance companies, as well...Hours 10 WORK BEHAVIOR 2 - INVESTIGATES PERSONAL INJURY CLAIMS AND THEIR ESTATES Investigates medical assistance… more
- TEKsystems (St. Louis, MO)
- …accurately, and pleasantly. Uphold the mindset of working together as a team. * Review and analyze medical claims for eligibility and benefits. * ... Medical Claims Processor Full-Time Opportunity Available... Medical Claims Processor Full-Time Opportunity Available TEKsystems is looking...is looking for someone to join a team of medical claims processors who advocate for members… more
- TEKsystems (St. Louis, MO)
- …accurately, and pleasantly. Uphold the mindset of working together as a team. + Review and analyze medical claims for eligibility and benefits. + ... Teksystems is currently looking for someone to join a team of medical claims processors who advocate for the Fund's members while maintaining the policies and… more
- US Tech Solutions (Columbia, SC)
- … claims and utilization practices. May provide any of the following in support of medical claims review and utilization review practices: Performs ... medical necessity guidelines. + Utilizes allocated resources to back up review determination. Reviews interdepartmental requests and medical information in a… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Role Brighton Health Plan Solutions provides Utilization Review / Case Management/ Medical Management/ Claims Review services to its clients. Care ... required + Previous experience in case management handling insurance claims a plus. + Strong skills in medical record review . + Familiarity with medical… more
- Amazon (Seattle, WA)
- …for vendor solutions and benefit programs. - Develop models and pricing analysis for medical outlier claims . - Review and recommend plan designs, plan ... producing clear and effective writing that informs and persuades - Experience with medical claims data (eg, DRG, CPT, ICD-10 diagnosis codes , etc.) - Associate… more
- Elevance Health (Grand Prairie, TX)
- …through normal channels. + Works with internal business partners (sales, member experience, claims , medical review , appeals, etc.) and external contacts ... to Plan emails and Blue 2 General inquiries. + Requests and routes medical records to medical review units. + Keys, processes and adjusts claims for all… more
- Lincoln County (Newport, OR)
- …who is reliable with a strong attention to detail. The person in this role will review medical claims , prior and subsequent to billing, to ensure accuracy ... + Employee Assistance Programs. Essential Functions/Major Responsibilities Billing and Coding: + Review charges prior to initial claims submission to ensure… more
- CareFirst (Baltimore, MD)
- … policy, quality improvement, disease management, utilization review , and dental/ medical claims review , network recruitment, credentialing, provider ... efficient productivity and decision-making alignment of clinical reviews for dental, medical quality of services and clinical Special Investigation Unit (SIU)… more
- Martin's Point Health Care (Portland, ME)
- …policies, and internal guidelines for medical necessity reviews. + Manage the review of medical claims disputes, records, and authorizations for billing, ... medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental… more
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