• Health Claims Specialists- Remote

    Sutherland Global Services (Raleigh, NC)
    …guidelines + Follow up on claims needing additional information + Refer problem claims to a Lead and/or auditor for additional review + Make sure that ... performance. Delivering measurable results._ This is a full-time permanent healthcare claims adjudicator position. A claims adjudicator determines how much… more
    Sutherland Global Services (11/06/24)
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  • Risk Management Liability Analyst

    Windstream Communications (Raleigh, NC)
    …risk management systems preferred. + Casualty claims handling as an adjuster or claims Team Lead or Supervisor experience. + Previous experience in a risk ... as a crucial liaison between Windstream employees, customers, and our Third-Party Claims Administrator (TPA). The role involves managing Third-Party Auto and General… more
    Windstream Communications (11/01/24)
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  • Lead Long Term Disability Claims

    MetLife (Cary, NC)
    …* Independently manage an assigned caseload of the most complex claims which consists of pending, ongoing/active and appeal reviews. Provides timely, ... balanced and accurate claims reviews, documentation and recommended decisions in a time...information is needed to make a reasonable and logical claims determination based off the information available. Proficiently calculates… more
    MetLife (08/30/24)
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  • Senior Product Manager

    J&J Family of Companies (Raleigh, NC)
    …aligned + Author the development of go-to-market strategy, value proposition and key claims + Lead successful commercial and operational introduction of new ... offering and market approach **Roadmap & Business Plan Development:** + Lead development of the business plan, initial value proposition, go-to-market approach,… more
    J&J Family of Companies (11/08/24)
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  • Pharmacy Point Of Sale Transition Claims

    Humana (Raleigh, NC)
    …caring community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures accuracy for pharmacy ... point of sale transition adjudicated claims logic. The Senior Pharmacy Claims Operations...update and maintain various reports and policy/procedure documents. + Lead projects with internal/external areas related to required process… more
    Humana (10/29/24)
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  • Claims Technical Analyst, Sr.

    Prime Therapeutics (Raleigh, NC)
    …fuels our passion and drives every decision we make. **Job Posting Title** Claims Technical Analyst, Sr. **Job Description** The Senior Claims Technical Analyst ... is responsible for serving as the claims analysis resource for assigned operations teams. This role is responsible for performing complex and escalated client,… more
    Prime Therapeutics (10/01/24)
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  • Claims Representative I (Health and Dental)

    Elevance Health (Durham, NC)
    ** Claims Representative I (Health and Dental)** **Location:** Remote, within 50 miles of an Elevance Health pulse point. **Hours:** An 8-hour shift, Monday - Friday, ... hours of 7 am - 6 pm EST. The ** Claims Representative I** is responsible for successfully completing the...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
    Elevance Health (11/05/24)
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  • Team Leader, Absence Claims Management

    Guardian Life (Raleigh, NC)
    The **Team Leader, Absence Claims Management** is responsible for leading a team of Absence Management Case Managers to get results within their team and the ... submit process improvement ideas to revise workflows and procedures. + Support claims initiatives by encouraging/providing relevant feedback and acting as a change… more
    Guardian Life (11/08/24)
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  • Medical Director-- Claims Management

    Humana (Raleigh, NC)
    …innovate + **Additional Information** Typically reports to a Director of Health Services, Lead , or Corporate Medical Director, depending on size of region or line of ... business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for… more
    Humana (10/29/24)
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  • Lead RPA Engineer

    Humana (Raleigh, NC)
    …part of our caring community and help us put health first** The Lead Automation Engineer identifies and implements solutions (hardware and software) for improvement ... operational efficiency, reduce manual processes, and improve accuracy in insurance claims processing, policy management, and other key areas. A strong background… more
    Humana (10/29/24)
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  • RPS Operations Manager

    Lincoln Financial Group (Raleigh, NC)
    …processes for efficiency, effectiveness, and reduced risk. **What you'll be doing** + You will lead the Death Claims and Money Out teams in an environment that ... As the Operations Manager, you will manage RPS Death Claims and RPS Money Out teams. You will oversee...You will partner and build relationships cross functionally that lead to providing an exceptional customer experience. You will… more
    Lincoln Financial Group (11/01/24)
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  • Data Science Lead Analyst (Medicare)…

    The Cigna Group (Raleigh, NC)
    **Summary** The Data Scientist Lead Analyst will contribute to the Medicare Clinical and Customer strategy, performing research and analysis within the Clinical, ... & Customer Data Science, the data scientist will analyze healthcare claims , clinical outcomes, customer enrollment patterns, and financial information to make… more
    The Cigna Group (09/28/24)
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  • Business Analytics Lead Analyst (Medicare…

    The Cigna Group (Raleigh, NC)
    …Strategic Analytics. Reporting to the Manager of Care Management Analytics, the lead analyst will analyze healthcare claims and clinical outcomes associated ... **Summary** The Business Analytics Lead Analyst will be responsible for performing reporting...clinical metrics. **Responsibilities** + Extract and analyze large healthcare claims using Toad, SQL, SAS, Teradata, etc. + Use… more
    The Cigna Group (10/25/24)
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  • Associate Director, Global Labeling Lead

    Takeda Pharmaceuticals (Raleigh, NC)
    …therapies to patients worldwide. Join Takeda as Associate Director, Global Labeling Lead where you will be responsible for the development and implementation of ... Cross-Functional Team (GLOC) + In alignment with TAU/MPD Labeling Lead , coordinates the process to obtain labeling approval by...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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  • Lead Service Technician

    Grundfos (Raleigh, NC)
    Lead Service Technician + Apply Now + Start...and ensures that these are submitted on time (warranty claims , working hours FAS etc); + Assists in project ... **What is the job about?** Grundfos is seeking a Lead Service Technician to join our Service Delivery team...team to be based in North Carolina. As a Lead Service Technician, you will be responsible for the… more
    Grundfos (09/28/24)
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  • Lead , Sales Insights

    Chiesi (Cary, NC)
    Lead , Sales Insights Date: Oct 15, 2024 Department: Business Excellence Job Type: Direct Employee Team: Mktg, Market Access, Bus. Excellence & Med. Affair Contract ... us is Chiesi." **_Who we are looking for_** **Purpose** Lead , Sales Insights is a key contributor to the...etc.) + Knowledge of secondary patient-level data sources including claims , EMR, GPO, IQVIA or other relevant pharmaceutical data.… more
    Chiesi (09/28/24)
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  • Director, Global Labeling Strategy Lead

    Takeda Pharmaceuticals (Raleigh, NC)
    …with immunologic, hematologic, and other complex diseases. The Director, Global Labeling Strategy Lead is a key role in the PDT R&D organization accountable for the ... issues to Global Labeling management and the Global Regulatory Lead (GRL) and proposes risk mitigation strategies for assigned...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more
    Takeda Pharmaceuticals (11/08/24)
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  • Lead Buyer

    SMX (Raleigh, NC)
    Lead Buyer (3727)at SMX(View all jobs) (https://www.smxtech.com/careers/) United States SMX is seeking a skilled ** Lead Buyer** to provide buying support for our ... order. * Negotiates and settles with vendors regarding damage claims , rejections, losses, return of materials, overages, cancellations, and...* Provides guidance to less experienced Buyers. * May lead a small team of Buyers on large programs… more
    SMX (08/14/24)
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  • Financial Analytics Lead

    Humana (Raleigh, NC)
    …services. **Responsibilities:** The Value-Based finance team is seeking a Financial Analytics Lead . This individual will work across the business, and will be highly ... to support critical business decisions and optimize outcomes. + Lead design and development of Power BI reporting and...to leadership. + Partner with DH&A team to evaluate claims data to drive deeper insights into the business… more
    Humana (10/29/24)
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  • Lead IT Business Process Analyst…

    HomeSafe Alliance (Raleigh, NC)
    **Title:** Lead IT Business Process Analyst (Deltek/Costpoint) **_HomeSafe Alliance_** is the single global household goods movement manager of over 300,000 Military ... better than the last. **_About the Role:_** As the Lead IT Business process analyst, you will work with...Create Custom tables and views for non-native functionality (ie, Claims )​ and develop custom logic in Costpoint​ + Integrate… more
    HomeSafe Alliance (10/05/24)
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