- Trustmark (Raleigh, NC)
- …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 (Raleigh, NC)
- …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
- Zurich NA (Raleigh, NC)
- …Office, AM - Remote Work (US) Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-MD1 #LI- DIRECTOR ... Sr. Claims Specialist - Complex Construction Claims 117562 Zurich North America is seeking a skilled and experienced Senior Claims Specialist to join our… more
- Takeda Pharmaceuticals (Raleigh, NC)
- …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
- United Therapeutics (Research Triangle Park, NC)
- …the pharmaceutical and biotech industry, including FDA advertising and promotion, False Claims Act, Anti-Kickback Statute, OIG Guidance, the PhRMA Code, the Sunshine ... Compliance departments related to the Food Drug and Cosmetic Act, the False Claims Act, Anti-Kickback Statute, the Sunshine Act and other healthcare related laws and… more
- IQVIA (Durham, NC)
- …capabilities to a health plan: data & analytics, interoperability, claims processing, population health.** + Exemplary interpersonal, relationship building, ... negotiations, and professional skills. + Confident, assertive, results driven, strong organizational skills and self-motivated, self-starter. + Must be self-motivated, have the internal drive to keep calling even when not getting traction immediately and have… more
- HealthEdge Software Inc (Raleigh, NC)
- **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
- Educational Testing Service (Raleigh, NC)
- …education and ed tech space as it continues to grow and evolve. The Executive Director of Learning Design will lead the strategy for how ETS develops learning and ... assessment solutions in the K16 Business Unit. The Executive Director will lead a team of learning scientists, instructional designers, user experience research and… more
- Humana (Raleigh, NC)
- …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
- Prime Therapeutics (Raleigh, NC)
- …we make. **Job Posting Title** Clinical Research Analyst, Senior - Remote **Job Description** The Senior Clinical Research Analyst works collaboratively within ... data output using eligibility data, medical and pharmacy administrative claims . The individual will support pharmaceutical manufacturer value-based contract… more
- Prime Therapeutics (Raleigh, NC)
- …and drives every decision we make. **Job Posting Title** Data Scientist- REMOTE **Job Description** The Principal Data Scientist is an independent statistical ... program impact measurement using eligibility, medical, and pharmacy administrative claims and external data, (eg, care management, disease management, laboratory,… more
- Prime Therapeutics (Raleigh, NC)
- …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 (Raleigh, NC)
- …AM - Remote Work (US) Remote Working: Yes Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-LC1 #LI- DIRECTOR #LI- REMOTE ... a Property Executive General Adjuster to support our Property Claims division. At Zurich North America Claims ...choosing your next career move. This position is 100% remote and can work anywhere in the United States.… more
- Zurich NA (Raleigh, NC)
- …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
- American Institutes for Research (Chapel Hill, NC)
- …to the analysis of healthcare data and provide support to the project director and/or senior team members on various tasks including querying large datasets ... including Medicare, Medicaid, and commercial payer claims data, cleaning and imputing data, creating analytic data files according to technical specifications,… more
- Zurich NA (Raleigh, NC)
- …Office, AM - Oregon Virtual Office Remote Working: Yes Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-LB1 #LI- DIRECTOR ... prospect/existing customer base. + Providing periodic support to the Claims Department with technical assessment of complex claims...for resume submission. Location(s): AM - Schaumburg, AM - Remote Work (US), AM - Dallas, AM - San… more
- Intermountain Health (Raleigh, NC)
- …Compensation Analyst provides compensation support and analysis for the Director of Physician Compensation, Manager of Physician Compensation, Medical Group, ... Recruiting, Professional Staff Services, and other leaders. **This is a 100% remote position** **however, currently we are unable to consider candidates for … more
- Robert Half Office Team (Durham, NC)
- …refer organization determinations that require a clinical review to a nurse or Medical Director . * Utilize various systems including RX Claims MHR Care Radius ... maintaining a strong focus on organization and confidentiality. The position is remote , with support provided in Eastern Standard Time, and offers a long-term… more
- HomeSafe Alliance (Raleigh, NC)
- …with GHC pricing requirements and report actual performance monthly to the Director of International Operations (DIOps) + Verify and assess accuracy of transit ... risks of not meeting RDDs as directed by the Director of International Operations, for all shipments that may...International Operations, for all shipments that may create inconvenience claims for HomeSafe. Formats and data requirements to be… more
- Motion Recruitment Partners (Durham, NC)
- Utilization Management Specialist Durham, NC **100% Remote ** Contract $17/hr - $17/hr Our client, a nationally recognized and award-winning company in the health ... while reducing costs. **Location:** ** While the position is Remote , work from home, you must reside in North...require a clinical review to a nurse or Medical Director . * Conducts reviews of authorizations entered to ensure… more