- Prime Therapeutics (Providence, RI)
- …that. It fuels our passion and drives every decision we make. **Job Posting Title** Senior Claims Operations Business Analyst - Remote **Job Description ... Summary** Serves as liaison between departmental team business owners, end users, IT, Claims and...Medicare, requires 3+ years of experience working in Medicare Operations . **Work Experience** Work Experience - Required: Business… more
- Humana (Providence, RI)
- …caring community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures accuracy ... of sale transition adjudicated claims logic. The Senior Pharmacy Claims Operations Professional...**Responsibilities** The Senior Pharmacy Claims Operations Professional analyzes, monitors and enhances business … more
- Prime Therapeutics (Providence, RI)
- …make. **Job Posting Title** Claims Technical Analyst, Sr. **Job Description** The Senior Claims Technical Analyst is responsible for serving as the claims ... This role is also responsible for providing training and mentorship to Claims Technical Analysts and Associate Analysts, along with leading process improvement and… more
- HealthEdge Software Inc (Providence, RI)
- …integrated solutions suite includes the industry's leading, digital, next-generation claims administration processing system, business intelligence, integration ... **Overview** ** Senior Manager, Product Operation** **Position Overview:** We areseekinga...our product teams to solve hard problems-customer problems and business problems-in ways that our customers love and that… more
- MetLife (Warwick, RI)
- …a month for office meetings Key Responsibilities: * Conduct quality reviews of LTD claims of various complexity * Identify trends, root causes and quality gaps from ... and management regarding performance and quality standards * Partners with team and claims organization to develop criteria and standards in which to measure quality… more
- CVS Health (Providence, RI)
- …which contain multiple issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and ... Serves as point person for newer staff in answering questions associated with claims /customer service systems and products. Educates team mates as well as other… more
- PPL Corporation (Providence, RI)
- …bonds, or obtaining parental guarantees. + Analyze and develop company position on claims and disputes and subsequently consult with senior management to ... force in the cities and towns where we do business , providing support for programs and organizations that empower...parental guarantees. + Analyze and develop company position on claims and disputes and subsequently consult with senior… more
- Sedgwick (Providence, RI)
- …work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Senior Vice President Business Development **PRIMARY PURPOSE:** To expand and ... their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our… more
- HealthEdge Software Inc (Providence, RI)
- …are identified and addressed upstream, and all aspects of claims operations are centralized for comprehensive business intelligence. The complete suite of ... in claims processing. The successful candidate will be responsible for taking a senior level role in analyzing claims data, as well as translating contract… more
- Zurich NA (Providence, RI)
- Senior US International Reverse Flow Underwriter 117849 Zurich is seeking a senior level US International Reverse Flow Underwriter to join our International ... Operations team in our Schaumburg, IL North America Headquarters....provide US underwriting support for incoming received country (RC) business from non-US producing countries. In this model the… more
- Evolent Health (Providence, RI)
- …products. You will collaborate with cross-functional teams, including solution strategy, business operations , engineering, quality assurance, and IT, to ensure ... You'll Be Doing:** **What You'll Be Doing:** As a Senior Product Analyst, you will have the opportunity to...market, and the customers. They collaborate with implementation teams, business operations , engineering, and growth teams to… more
- Prime Therapeutics (Providence, RI)
- …across the organization to validate regulatory requirements are met and that business operations are aligned with expectations of applicable regulatory guidance ... guidance and regulatory issues that impact Prime's compliance programs or business operations ; document requirements or disciplinary actions and escalate… more
- US Tech Solutions (Woonsocket, RI)
- **Position Summary:** **Duties** The Strategic Marketing Senior Manager will support the business . They will drive forward our marketing goals through helping ... regular benchmarking to understand how other retailers/competitors market their loyalty business ( claims /benefits, marketing campaign insights, etc.) * Ability… more
- Humana (Providence, RI)
- …support the strategic direction and growth of the Medicaid and Duals lines of business . This is a unique opportunity for a motivated individual to influence the ... successfully position Humana to enter new markets enabling the future of the business . As a centrally positioned strategic function this team coordinates with growth… more
- CVS Health (Providence, RI)
- …as Minute Clinic locations begin expanding into Primary Care. The Senior Manager, Payer Relations designs, develops contracts, maintains, and enhances relationships ... with payers, establishing reimbursement rates, terms, and conditions that align with business objectives and financial goals. + Creates and maintains strong working… more
- Fujifilm (Providence, RI)
- …please visit_ _healthcaresolutions-us.fujifilm.com_ _._ **External US** **Job Title:** ** Senior Compliance Specialist** **Job purpose** The accomplished Senior ... Compliance Specialist will support FUJIFILM's Corporate compliance program operations to ensure high ethical standards are observed and compliance program is… more
- IDEX (Middleboro, MA)
- …an impact. With interesting opportunities in engineering, marketing, sales, supply chain, operations , HR, finance, and more across more than 40 diverse businesses ... (https://www.idexcorp.com/our-businesses/ business -segments/) around the globe, chances are, we have something...something special for you. **SCOPE OF THE ROLE** The Senior Design Engineer is responsible for the development and… more
- Cardinal Health (Providence, RI)
- …colleagues as a coveted member of the Product Experience organization. As a Senior Product Experience Designer, you will define, lead, and implement the analytics ... their practices' financial performance. These products help monitor drug utilization, claims payment and denials, reimbursement trends, margins, and provide insights… more
- Cardinal Health (Providence, RI)
- …of data to create innovative solutions that improve patient outcomes, streamline operations , and enhance the overall healthcare experience. We are seeking a highly ... Difference: Contribute to cutting-edge solutions that improve patient care, enhance healthcare operations , and drive positive change in the industry. + Work with a… more
- CVS Health (Providence, RI)
- …abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and ... tools, social media and internet research. + Ability to Travel for Business purposes. **Preferred Qualifications** + Certified Professional Coder (CPC), AHFI, CFE +… more