- Sedgwick (Nashville, TN)
- …Most Loved Workplace(R) Forbes Best-in-State Employer Workers Compensation Claims Manager | VA Jurisdiction | Remote **PRIMARY PURPOSE** : To manage the ... + Establishes policy and procedure to assure compliance to best practices, claims management services standards, state regulations and client service requirements. +… more
- Sedgwick (Nashville, TN)
- …and support systems. + Effectively communicates and builds relationships with the claims ' examiner, client, injured worker , attorney and supervisor. + Identifies ... Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Telephonic Case Manager **PRIMARY PURPOSE OF THE ROLE:** While partnering with the injured … more
- Elevance Health (Nashville, TN)
- **Anticipated End Date:** 2024-09-23 **Position Title:** CarelonRx Account Manager II **Job Description:** **CarelonRx Account Manager II** **Location:** This ... position will work a hybrid model ( remote and office). The ideal candidate must live within...PulsePoint locations listed on the requisition. The **CarelonRx Account Manager II** is responsible for retention and operational excellence… more
- Elevance Health (Nashville, TN)
- …Payment Integrity line of business** _Location: This position will work a hybrid model ( remote and office). The ideal candidate will live within 50 miles from our ... of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. **How you… more
- Elevance Health (Nashville, TN)
- …Group Clinical Validation Auditor** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50 miles of one of ... Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Nashville, TN)
- …any Elevance Health office location_ _**this position will work a hybrid model ( remote and office) which requires working in the nearest Elevance Health office 1-2 ... office**_ The **Provider Reimburse Admin** ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing… more
- Elevance Health (Nashville, TN)
- …Title:** eCOB Specialist I **Job Description:** **eCOB Specialist I** **Location** : Remote , within 50 miles of an Elevance Health pulse point. **Hours:** Monday ... identify the correct formulas in order to adjudicates impacted claims , using multiple COB Formulas for the various product...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Nashville, TN)
- …**Pharmacy Internal Auditor** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50 miles of one ... processes and processes related to enrollment and billing and claims processing, as well as customer service written and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Nashville, TN)
- …Investigator II **Job Description:** **Location:** This position will work a hybrid model ( remote and office). The ideal candidate will live within 50 miles of one ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Elevance Health (Nashville, TN)
- …Information Consultant Senior** **Location** : This position will work a hybrid model ( remote and in office one day per week). Ideal candidates will live within ... background. **Preferred Skills, Capabilities, and Experiences:** + Experience with Clinical, Claims , Risk Adjustment, and/or HEDIS data. + Expert level PC,… more
- Elevance Health (Nashville, TN)
- …and pricing mechanisms.. **Location:** This position will work in a hybrid model ( remote and office). The Ideal candidate will live within 50 miles of one ... + Provides analytic support during complex provider negotiations. + Analyzes claims experience to identify cost of care initiative opportunities. + Measuring… more
- Elevance Health (Nashville, TN)
- …Contract/Cost of Care Analyst Senior** **Location:** This position will work a hybrid model ( remote and in office 1 - 2 days per week). Candidates must live within ... of Care and/or Provider Contracting organizations, while focusing efforts on lowering claims costs, improving the quality of care, and increasing member and provider… more
- Elevance Health (Nashville, TN)
- …**Advanced Analytics Analyst Senior** **Location:** This position will work a hybrid model ( remote and in office 1 - 2 days per week). Candidates must live ... procedures. * Develops and analyzes business performance reports (eg for claims data, provider data, utilization data) and provides notations of performance… more
- Elevance Health (Nashville, TN)
- …in-office) with PulsePoint sites used for collaboration, community, and connection. This includes remote work and 1-2 days in office per week. Candidates must reside ... increments or decrement. + Communicates with sales, administration and claims to assess the rating and administrative impact or...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more