- Commonwealth Care Alliance (Boston, MA)
- …under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible ... Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for...and Analytics + Direct and relevant experience with HCFA/UB-04 claims management , coding rules and guidelines, and… more
- Ryder System (Providence, RI)
- …of assigned staff. Assists Director with other staff as directed. Work with Director and other management team to develop tactics and strategies to achieve ... staff. Handles commercial lines bodily injury and property damage claims as well as insurance and contractual coverage issues....annual metrics and other KPI's + Participates with the Director in the selection and management of… more
- CVS Health (Providence, RI)
- …during the plan year. The **Medicare** **Benefits Standards & Guidance Lead Director ** ensures accountability for the implementation, management , and maintenance ... Employer Groups. The **Medicare** **Benefits Standards & Guidance Lead Director ** acts as the point of contact to our...such as Benefit & Product Strategy, Benefits & Product claims configuration, Medicare Service Operations (MSO), Medical … more
- Humana (Providence, RI)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the… more
- Humana (Providence, RI)
- … management or utilization management . **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests… more
- Merck (Providence, RI)
- **Job Description** The Hematology Regional Medical Scientific Director , RMSD, is a credentialed (ie, MD, PhD, or PharmD) therapeutic and disease expert who ... engages in scientific exchange with leaders in the external medical and scientific community. Scientific exchange does not include promotional claims about any… more
- EPAM Systems (Boston, MA)
- …driving strategic and operational excellence across client functions such as underwriting, claims and distribution management . You will contribute to the ... - go-to-market, sales, engagement delivery and practice development. As a **Managing Director - Insurance Advisory** , you will lead the demand generation, pursuit,… more
- Prime Therapeutics (Providence, RI)
- …our passion and drives every decision we make. **Job Posting Title** Senior Director of Underwriting - REMOTE **Job Description** The Sr. Director Underwriting ... for prospective clients and new customer acquisitions. **Responsibilities** + Analyze claims data and develop cost-of-care projections for existing customer renewals… more
- Takeda Pharmaceuticals (Boston, MA)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... guidance. **How you will contribute:** With guidance from leadership: Management of Labeling Cross-Functional Teams + Independently leads Labeling cross-functional… more
- Sedgwick (Boston, MA)
- …to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Marketing Analytics Director **PRIMARY PURPOSE OF THE ROLE:** The Marketing Analytics Director ... growth opportunities + A diverse and comprehensive benefits offering including medical , dental vision, 401K, PTO and more Work environment requirements for… more
- EFI Global (Boston, MA)
- …rounding ability + Strong understanding of workers compensation, liability and disability claims management + In-depth knowledge of client servicing + Ability ... to learn more about EFI Global. **We are seeking a Client Services Director with experience in the insurance industry, specifically in executive general adjusting… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …us transform healthcare? Bring your true colors to blue. What We Need The Associate Director of Data Governance & Analytics Success will be a key leader in executing ... governance functions. + Implement technology solutions to enable robust data lifecycle management , improve data quality and standards, and self service analytics. +… more
- Takeda Pharmaceuticals (Boston, MA)
- …and cross-functionally (Regional Marketing, Market Research, Business Intelligence, BD, Alliance Management , Patient Value and Access, Medical Affairs etc.), to ... clinical development decisions within the GPT (including Clinical, GMA, Project Management , and Regulatory) on key factors such as indications, endpoints,… more
- Trustmark (Providence, RI)
- …+ Collaborate with the sales leadership teams of VP of Sales & Client Management , Senior Directors' Sales, and the whole sales team to maximize opportunities. + ... accounting of activities and sales. + Collaborate with and support the Client Management team to assure persistency goals are being achieved. + Review national… more
- Fallon Health (Worcester, MA)
- …detection and analysis, and laws/regulations related to fraud and general risk management . Medical claim terminology, coding, and managed care expertise or ... direction of the Senior Internal Audit Manager, theAnalyze and interpret patient medical records pertaining to FWA investigations Compare to information submitted on… more
- Point32Health (Canton, MA)
- …/ management consultancy or auditing firm. + Understanding of claims systems, provider information, Medicaid/Medicare, and/or experience working with large data ... click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the supervision of the Director of Data and Reporting, this individual will be responsible for… more
- Intermountain Health (Boston, MA)
- …on-going credentialing / privileging process and other administrative functions for the Medical Staff, Medical Director , Administration, and Allied Health ... assistant- + Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) within four (4) years of… more
- Stantec (Boston, MA)
- …and forecasting. + Experience with scheduling large, complex projects. + Experience with claims management for design projects. + Sound knowledge and experience ... context of the communities we serve, we provide planning, engineering, and infrastructure management services that fit the needs of our clients and improve the… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …the DFCI Quality and Patient Safety (QPS) Department. Under the direction of the Director of Risk Management , the Risk Manager is responsible for identification, ... require investigation or intervention, + Identifying trends and high-risk areas for risk management attention in collaboration with the Director of Risk … more
- Beth Israel Lahey Health (Boston, MA)
- …analysis of diverse data sources, including large national registries, administrative claims data, survey-based data, and EHR data. The Biostatistician II will ... to produce high-impact research. The Biostatistician II will carry out select data management and analytic activities for a variety of projects in support of the… more