• Managed Care , Claims

    Zurich NA (Phoenix, AZ)
    Managed Care , Claims Vendor Management Sr Specialist 118916 Zurich North America is seeking a Managed Care , Claims Vendor Management ... United States. **About the Role** As a Senior Specialist in Managed Care and Claims Vendor Management, you will play a key role in administering… more
    Zurich NA (12/18/24)
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  • Director, Claims Recovery Unit

    Banner Health (AZ)
    …APR-DRG; prior clinical or coding supervisory or management experience in managed care environment. Excellent communication, presentation and written skills ... you. Recognized nationally as an innovative leader in health care , Banner Plans & Networks (BPN) integrates Medicare and...offering remote and hybrid work settings. As a Director, Claims Recovery Unit, you will lead a small team… more
    Banner Health (12/18/24)
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  • Director, Payment Integrity (Payer Operations…

    Molina Healthcare (AZ)
    …Coordination of Benefits experience. + Experience with **_BPaaS solutions_** and Medicaid Managed Care programs. + Strong understanding of **_SQL and relational ... optimizing operational process designs, setting procedural standards, and overseeing vendor operations to ensure compliance with key performance indicators (KPIs)… more
    Molina Healthcare (12/09/24)
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  • AVP, Clinical Validation (Payment Integrity)…

    Molina Healthcare (AZ)
    …experience and demonstrated success in relevant Clinical Review Programs * 5+ years Managed Care payor experience, preferably Medicare / Medicaid experience * ... Claims Adjudication accuracy including configuration in QNXT (ie Claims Production, Audit, Production Vendor Oversight) for...all lines of business, which may also include the Care Management application for UM functions within QNXT: +… more
    Molina Healthcare (11/07/24)
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  • Sr Analyst, Performance Suite Analytics

    Evolent (Phoenix, AZ)
    …experience in claims -based healthcare analytics with a payer, provider, clinical vendor , managed care , or related healthcare consulting entity- ... people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care more
    Evolent (12/18/24)
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  • Sr Analyst, Medical Economics - REMOTE

    Molina Healthcare (AZ)
    …healthcare vendor , commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft Excel ... utilized in medical coding/billing (UB04/1500 form) + Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk… more
    Molina Healthcare (11/16/24)
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  • Mgr, Enrollment

    Molina Healthcare (AZ)
    …and strong system knowledge of QNXT and other state specific applications concerning Managed Care Enrollment. + Responsible for ensuring timely reconciliation of ... education and experience **Required Experience** 5-7 years Enrollment-related experience in Managed care or Medicare setting **Preferred Education** Graduate… more
    Molina Healthcare (12/19/24)
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  • Manager, Fraud and Waste * Special Investigations…

    Humana (Phoenix, AZ)
    …7+ years of related compliance and/or special investigation experience in managed care or CMS. + Prior health insurance claims experience + Demonstrated ... Attend federal CMS and state fraud meetings with other managed care organizations, as well as state...exciting interviewing technology provided by Modern Hire, a third-party vendor . This technology provides our team of recruiters and… more
    Humana (12/19/24)
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  • Business Consultant

    HealthEdge Software Inc (Phoenix, AZ)
    …Practical understanding of the healthcare system with regards to Medicare, Medicaid, managed care , and commercial payment methodologies, payment integrity, and ... and maintenance of provider rate and/or claim editing provisions in a claims adjudication system and/or third-party vendor application. + Working knowledge… more
    HealthEdge Software Inc (12/18/24)
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  • Associate Director, Global Labeling Lead - Remote

    Takeda Pharmaceuticals (Phoenix, AZ)
    Vendor Management + Oversight and accountability for labeling activities managed by external vendor (s) for assigned products, ensuring seamless coordination, ... labeling requirements to be provided to patients and Health Care Providers while minimizing the risk of write-offs. +...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more
    Takeda Pharmaceuticals (10/16/24)
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  • AVP, Business Operations - Medical Policy…

    CVS Health (Phoenix, AZ)
    …of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at ... accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. **Position Summary** At Aetna, our health… more
    CVS Health (12/20/24)
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  • Data Center Inventory & Asset Technician

    Microsoft Corporation (Phoenix, AZ)
    …and outbound deliveries as instructed by management. You will initiate warranty claims and process returns on failed equipment. This opportunity will allow you ... Centers in 32 countries and millions of servers. Our foundation is built upon and managed by a team of subject matter experts working to support services for more… more
    Microsoft Corporation (12/20/24)
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  • Data Center Inventory & Asset Technician (West…

    Microsoft Corporation (Phoenix, AZ)
    …and outbound deliveries as instructed by management. You will initiate warranty claims and process returns on failed equipment. This opportunity will allow you ... Centers in 32 countries and millions of servers. Our foundation is built upon and managed by a team of subject matter experts working to support services for more… more
    Microsoft Corporation (12/14/24)
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