- Humana (Annapolis, MD)
- …level by driving real impact and shaping the future of claims management? As a Senior Pharmacy Claims Professional , you will play a pivotal role in ... and take the lead on building solutions that make a difference! The Senior Pharmacy Claims Professional analyzes and answers inquiries regarding… more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Senior Pharmacy Claims Professional adjudicates pharmacy claims and ... process pharmacy claims for payment. The Senior Pharmacy Claims Professional work assignments involve moderately complex to complex issues where… more
- Elevance Health (Washington, DC)
- **Account Service Manager Sr - Pharmacy Account Management** **Location:** This position will work a hybrid model (remote and office). The ideal candidate must live ... plan design, researching and resolving phone and written inquiries, resolving claims , benefit and enrollment issues. + Presents monthly, ad hoc, mid-year,… more
- CareFirst (Baltimore, MD)
- …risk score methodology, risk score calculation, ACA enrollment, premiums, medical and pharmacy claims , and provider data. Incumbent is responsible for performing ... **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Analyst assumes a pro-active approach...as required. **_Note:_** **_We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is… more
- Humana (Washington, DC)
- …Benefit Manager, Pharmacy , or Healthcare data, in particular drug utilization, claims , costs and forecasting + Experience with techniques that can improve our ... help us put health first** Humana is seeking a Senior Economist to lead the development and management of...in applying econometric techniques to real-world problems, with either professional work experience or publication history + Ability to… more
- Deloitte (Washington, DC)
- Life Sciences Market Access Senior Manager An evolving customer and regulatory landscape, mounting pipeline of next-gen assets and portfolio pressures, and ... + Lead team in development of quantitative and/or qualitative analysis (eg, claims data analysis, market research data) to drive meaningful insights for our… more
- Elevance Health (Hanover, MD)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for identifying and ... healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding,… more
- RELX INC (Annapolis, MD)
- Senior Director-Product ManagementAre you a thought leader and innovator seeking a new opportunity? Would you like to lead a team to solve complex business problems? ... Team leads the strategy and development of Healthcare solutions, leveraging provider, claims , and consumer data to provide insights for Healthcare Payer, Provider,… more
- CenterWell (Silver Spring, MD)
- …team at the branch to ensure other billing requirements are satisfied to release claims timely. + Adhere to and participate in Agency's mandatory HIPAA / Privacy ... Guidelines. + Managing all incoming telephone calls in a professional manner including: + Screen and route calls to...at the center. As the nation's largest provider of senior -focused primary care, one of the largest providers of… more