- Sedgwick (St. Paul, MN)
- …place to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Director - Complex Claims **PRIMARY PURPOSE** **:** To be ... responsible for the day to day activities of the complex claims unit, to assess the work done by the unit, and develop and improve the individuals within the… more
- Humana (St. Paul, MN)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Humana (St. Paul, MN)
- …of our dynamic Wisconsin leadership team in this position as the Director , Consumer Service Operations. This position works with insurance companies, providers, ... members, and collection services in the settlement of claims through Call Center operations. Comprised of a team of claims associates researching & resolving the… more
- Humana (St. Paul, MN)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... The Medical Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records,… more
- Humana (St. Paul, MN)
- …relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation and… more
- Humana (St. Paul, MN)
- …part of our caring community and help us put health first** The Director , Medicaid Trend Mitigation Strategy provides data-based strategic direction to identify and ... planning support for business segments or the company at large. The Director , Medicaid Trend Mitigation Strategy requires an in-depth understanding of how… more
- Humana (St. Paul, MN)
- …The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- Zurich NA (St. Paul, MN)
- …+ Understands, analyzes, and applies the component parts of an insurance policy for complex claims . + Ability to follow reserving process for indemnity and ... expense in analyzing the potential exposure of complex claims . + Ability to determine the...Remote Work (US) Remote Working: Yes Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-LC1 #LI- DIRECTOR … more
- Prime Therapeutics (St. Paul, MN)
- …or enhanced financial pricing strategies. This position will also lead highly complex financial pricing analyses, and provide consultation and analytic insight to ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more
- Prime Therapeutics (Eagan, MN)
- …requirements, process improvement, advanced research, root cause analysis, complex issue research, documentation, advanced communications, client interaction, ... researches, determines root cause and collaborates with others to resolve complex business and technical issues and customer inquiries. + Provides prompt… more
- Prime Therapeutics (St. Paul, MN)
- …new product development. **Responsibilities** + Analyze or produce reports of varied claims data to assess Prime's products and/or programs; utilize analytics to ... based upon large data sets and/or experience working with complex queries + 3 years of experience with dashboard...+ Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data… more
- Prime Therapeutics (St. Paul, MN)
- …with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness & ... accuracy of Prime's financial pricing programs against adjudicated claims to identify trends and draw insights to provide...accuracy + Demonstrated ability to problem solve and interpret complex data + Ability to work independently and meet… more
- Zurich NA (St. Paul, MN)
- …Liability Underwriter, (Sr. Level III or AVP Level IV) you will handle complex new and renewal domestic Construction Professional Liability accounts and serve as a ... Diploma or Equivalent and 10 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance Apprentice including an Associate… more
- Mathematica (St. Paul, MN)
- …data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and ... and Mathematica's contractual and regulatory requirements. * Act as Project Director on select awarded projects, ensuring successful execution from kickoff through… more
- Prime Therapeutics (St. Paul, MN)
- …Evaluates the utilization and financial experience of customers and prospects + Performs claims re-pricing analyses of moderately complex external claims ... and ability to adjust focus **Reporting Structure** + Reports to Manager or Director in the Finance Department Potential pay for this position ranges from $59,000.00… more
- Prime Therapeutics (St. Paul, MN)
- …The Senior Business Integration Consultant is responsible for leading multiple complex small to mid-sized client and/or product implementations, projects, analysis, ... and external leaders + Ability and desire to drive solutions for complex business needs (including operational and technical aspects) + Familiarity with project… more
- Prime Therapeutics (St. Paul, MN)
- …You would be tasked with helping to develop, build and manage complex clinical product initiatives.** The Principal Clinical Program Pharmacist is responsible for ... as established. **Responsibilities** + Understand, develop, build and manage complex clinical product initiatives including clinical criteria and associated data… more
- Prime Therapeutics (St. Paul, MN)
- …**Preferred Qualifications** + PBM (Pharmacy Benefit Management) experience + Experience conducting complex analysis on large sets of pharmacy, claims , medical, ... analysts + Develop analytic methodologies, models, reports and new products + Lead complex client analytical work efforts and serve as an internal subject matter… more
- Sedgwick (St. Paul, MN)
- …cloud-based infrastructure services in conjunction with senior IT management. The Director Infrastructure Services - Cloud designs and drives the implementation of ... Azure enterprise solutions. Must show proven ability to architect highly complex scalable cloud solutions across a global enterprise. **Skills & Knowledge**… more
- Prime Therapeutics (St. Paul, MN)
- …is responsible for managing, analyzing, and delivering Treasury reporting, including complex liquidity reporting and claim payment process reporting for a variety ... Team and guidance to the Accounting, Finance, Information Technology and Claims operation functions. **Responsibilities** : + Develop, manage, and advance monthly… more