- Trustmark (Providence, RI)
- …the best to our colleagues, clients and communities. Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner ... in accordance and compliant with government regulations. Develops claims adjudication policies and procedures that maximize the accuracy of claims payments.… more
- Humana (Providence, RI)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to...member PHI / HIPAA information + This is a remote position\#LI- Remote **Scheduled Weekly Hours** 40 **Pay… more
- Commonwealth Care Alliance (Boston, MA)
- …is Important to Us:** **Position 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 necessary coding configuration… more
- Takeda Pharmaceuticals (Providence, RI)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure...around the world. This position is currently classified as " remote " in accordance with Takeda's Hybrid and Remote… more
- EPAM Systems (Boston, MA)
- …be the perfect opportunity for you to join EPAM as a **Managing Director , Insurance Advisory** . Scroll down to learn more about the position's responsibilities ... operational capabilities **Requirements** + Prior experience as a Managing Director (Partner, or equivalent level) with primary client relationship responsibility… more
- HealthEdge Software Inc (Providence, RI)
- **Overview** ** Director , Product Management** **Position Overview:** We are seeking a highly skilled and experienced Director of Product Management to lead our ... and QE. We have divided our product teams into Value Streams (ie, Claims , Billing & Financials, Enrollment, BlueCard, Integration, and Platform). Each Value Stream… more
- GE Vernova (Foxborough, MA)
- …HVDC Solutions. In this context, Grid Solutions is looking for a Project Director who will be responsible for project on-time delivery, profit & loss accountability, ... up to receipt of the Provisional Acceptance Certificate (PAC). The Project Director will provide leadership to strategically manage risks & opportunities and ensure… more
- Cardinal Health (Providence, RI)
- …are used. **What this position contributes to Cardinal Health:** The Associate Director , Access and Patient Support (APS) is responsible for the tactical execution ... collaboration and integration with cross functional teams. The Associate Director oversees revenue and budget accountability, organizational development, and… more
- Humana (Providence, RI)
- …Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of… more
- Zelis (Boston, MA)
- Director , Partnership Marketing Zelis is a healthcare and financial technology company whose purpose is to improve the healthcare financial experience for all. Zelis ... that address the entire financial journey, helping to price and pay healthcare claims and empower consumers to make care decisions. Through its three business units,… more
- RELX INC (Cambridge, MA)
- Director of Data Content and Strategy About the business: LexisNexis Risk Solutions is the essential partner in the assessment of risk. Within our Healthcare ... and experienced professional to join our team as the Director of Data Content and Strategy. This critical role...Maintaining a deep understanding of relevant industry data, including claims , provider data, and patient insights. + Performing all… more
- Takeda Pharmaceuticals (Boston, MA)
- …to bring life-changing therapies to patients worldwide. Join Takeda as a Director , Patient-Centered Outcomes, Global Evidence and Outcomes in Cambridge, MA, where ... preferred. Regulatory understanding and experience in negotiating PRO label claims is strongly preferred. Experience with ePRO is strongly...around the world. This position is currently classified as " remote " by Takeda's Hybrid and Remote Work… more
- Trustmark (Providence, RI)
- …benefits products (ie, sales, implementation and enrollment, underwriting, billing, servicing, claims ) using DMAIC, PDCA, etc. methods. Develop the approach and ... small, mid-size, and complex/transformational projects, with support from the Executive Director , Digital Project Manager, as needed. Define baseline and target… more
- Takeda Pharmaceuticals (Cambridge, MA)
- …plasma-derived therapies for patients with immunologic, hematologic, and other complex diseases. The Director , Global Labeling Strategy Lead is a key role in the PDT ... to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure...classified as "hybrid" in accordance with Takeda's Hybrid and Remote Work policy. **Takeda Compensation and Benefits Summary** We… more
- Molina Healthcare (New Bedford, MA)
- **_ Remote and must live in Massachusetts _** **Job Description** **Job Summary** Provides leadership and direction to MMS Operational Units management staff (eg, ... Claims Processing, Provider Services, Provider Enrollment, Finance, Managed Care...goals with assigned department managers, in conjunction with the Director , Account Management so that department goals support overall… more
- Prime Therapeutics (Providence, RI)
- …Posting Title** Senior Compliance Analyst (Regulatory Compliants & Inquires) - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance ... Works independently to research and resolve regulatory inquiries/complaints related to claims , contracting and XXXX. Works directly with business partners across the… more
- Prime Therapeutics (Providence, RI)
- …every decision we make. **Job Posting Title** Treasury Reporting Principal - Remote **Job Description** The Treasury Analyst Principal is responsible for managing, ... Team and guidance to the Accounting, Finance, Information Technology and Claims operation functions. **Responsibilities** : + Develop, manage, and advance monthly… more
- Prime Therapeutics (Providence, RI)
- …every decision we make. **Job Posting Title** Regulatory Analyst Sr - Remote **Job Description** The Senior Regulatory Analyst is responsible for leading portions ... Programs, Compliance, Healthcare Reform, Legal, Networks, Clinical Operations, Paper Claims , Member Materials, IT, etc.) to ensure effective collaboration,… more
- Zurich NA (Providence, RI)
- …AM - Remote Work (US) Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-BN1 #LI- DIRECTOR #LI-HYBRID ... Zurich's Philadelphia office. We are also open to hiring remote talent. This role will be filled at either...and 10 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance… more
- State of Massachusetts (Boston, MA)
- …all aspects of the Family and Medical Leave Program relating to claims application processing. This includes managing the overall activities and functions of ... and maintain processes both internal and external to our claims management system that are compliant with state laws...draft policy content to be signed off on by director . 13. Make daily decisions on escalated employer and… more