- Zurich NA (Boston, MA)
- Managed Care , Claims Vendor Management Sr Specialist 118916 Zurich North America is seeking a Managed Care , Claims Vendor Management ... United States. **About the Role** As a Senior Specialist in Managed Care and Claims Vendor Management, you will play a key role in administering… more
- Fallon Health (Worcester, MA)
- …related to fraud and general risk management.Medical claim terminology, coding, and managed care expertise or clinical background. + Strong attention to ... our Program Integrity efforts. + Oversee any external FWA vendor (s) and make enhancement to the tool, reporting and...and capture results. + 5-8 years of related health care claims auditing experience in a complex… more
- Evolent (Boston, MA)
- …experience in claims -based healthcare analytics with a payer, provider, clinical vendor , managed care , or related healthcare consulting entity- ... people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care … more
- Humana (Boston, MA)
- …7+ years of related compliance and/or special investigation experience in managed care or CMS. + Prior health insurance claims experience + Demonstrated ... Attend federal CMS and state fraud meetings with other managed care organizations, as well as state...exciting interviewing technology provided by Modern Hire, a third-party vendor . This technology provides our team of recruiters and… more
- HealthEdge Software Inc (Boston, MA)
- …Practical understanding of the healthcare system with regards to Medicare, Medicaid, managed care , and commercial payment methodologies, payment integrity, and ... and maintenance of provider rate and/or claim editing provisions in a claims adjudication system and/or third-party vendor application. + Working knowledge… more
- Takeda Pharmaceuticals (Cambridge, MA)
- …** Vendor Management** + Oversight and accountability for labeling activities managed by external vendor (s) for assigned products, ensuring seamless ... up-to-date, compliant information is provided to patients and Health Care Providers while the risk of write- offs is...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more
- Takeda Pharmaceuticals (Boston, MA)
- … Vendor Management + Oversight and accountability for labeling activities managed by external vendor (s) for assigned products, ensuring seamless coordination, ... labeling requirements to be provided to patients and Health Care Providers while minimizing the risk of write-offs. +...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more