- Humana (Trenton, NJ)
- …and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized at the Inpatient ... communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or… more
- CVS Health (Trenton, NJ)
- …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 ... ability to innovate and deliver solutions to make health care more personal, convenient and affordable. This is a...advocate for themselves. The TOC team will review prior claims to address potential impact on current case management… more
- Liberty Healthcare Corporation (Bala Cynwyd, PA)
- …Corporation seeks to hire an experienced attorney for a new Senior Associate General Counsel position which will focus on litigation and employment matters. ... and presenting quarterly and annual reports related to litigation and claims . + Managing insurance coverage analysis, carrier communications and coordination related… more
- Takeda Pharmaceuticals (Trenton, NJ)
- …in order to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director, Global Labeling Lead where you will be responsible for the ... 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
- The Cigna Group (Trenton, NJ)
- …have a background in customer service or experience in healthcare, specifically benefits and claims processing, you might be the perfect fit to join our team as a ... Care Navigator Representative. As a Care Navigator,...driving a consistently accurate quality of service. **QUALIFICATIONS:** + Associate degree or higher required and/or 4+ years' work… more
- Merck (North Wales, PA)
- …Director/Senior Director in the Office of Promotion and Advertising Review (OPAR) The Associate Director is responsible for the review and approval of all US ... meetings to ensure support for anticipated promotional messages and claims (aligned with marketing strategy) in clinical trial design...or BS degree with an emphasis in science, health care or related fields. + Preferred: Master's, PhD or… more
- Humana (Trenton, NJ)
- …and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are ... payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes,...**What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company… more
- AmeriHealth Caritas (Philadelphia, PA)
- …in either English or in Spanish language. + Minimum 4 years' experience in claims and/or call center. + Associate degree preferred; Minimum 45 wpm typing ... Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care ,… more
- Humana (Trenton, NJ)
- …first** Humana's Clinical Analytics Team is seeking a Lead Research Scientist ( Remote ). Healthcare is rapidly changing, and our members are living longer, often ... clinical concepts and extract clinical information from medical, pharmacy, and lab claims for analytics and modeling purposes + Translates analytic results into key… more
- Amgen (Trenton, NJ)
- …in the public or private third-party access arena or pharmaceutical industry in managed care , clinical support, and/or sales OR Associate degree AND 10 years of ... insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution + Educate offices using approved materials + Review… more
- Humana (Trenton, NJ)
- …first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products...protect member PHI / HIPAA information This is a remote position \#LI- Remote **Scheduled Weekly Hours** 40… more
- Humana (Trenton, NJ)
- …working with health insurance operations related data to include enrollment, claims , billing and Reconciliation and/or contact center (Call center) data **Additional ... Information** **Work Style** : Remote **HireVue Statement** : As part of our hiring...(collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and… more
- Humana (Trenton, NJ)
- …Degree + CAS, MTV, PAAG, or APEX systems experience + Claims experience + Provider data management data loading/analysis/review **Additional information** ... ongoing interruptions to protect member PHI / HIPAA information. This is a remote position \#PPNO **Scheduled Weekly Hours** 40 **Pay Range** The compensation range… more