- Zurich NA (Lansing, MI)
- 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
- Molina Healthcare (MI)
- …Coordination of Benefits experience. + Experience with **_BPaaS solutions_** and Medicaid Managed Care programs. + Strong understanding of **_SQL and relational ... optimizing operational process designs, setting procedural standards, and overseeing vendor operations to ensure compliance with key performance indicators (KPIs)… more
- Molina Healthcare (MI)
- …experience and demonstrated success in relevant Clinical Review Programs * 5+ years Managed Care payor experience, preferably Medicare / Medicaid experience * ... Claims Adjudication accuracy including configuration in QNXT (ie Claims Production, Audit, Production Vendor Oversight) for...all lines of business, which may also include the Care Management application for UM functions within QNXT: +… more
- Evolent (Lansing, MI)
- …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
- Molina Healthcare (MI)
- …healthcare vendor , commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft Excel ... utilized in medical coding/billing (UB04/1500 form) + Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk… more
- Molina Healthcare (Grand Rapids, MI)
- …and strong system knowledge of QNXT and other state specific applications concerning Managed Care Enrollment. + Responsible for ensuring timely reconciliation of ... education and experience **Required Experience** 5-7 years Enrollment-related experience in Managed care or Medicare setting **Preferred Education** Graduate… more
- Henry Ford Health System (Troy, MI)
- …roadblocks and meet or exceed customer requirements and expectations. + Knowledge of medical claims data and managed care membership data. + Knowledge of ... with medical cost containment initiatives. Analyze medical and pharmacy claims to identify early signs of trends or other...years of progressive analytical experience in a healthcare or managed care /insurance related setting. + Minimum of… more
- Humana (Lansing, MI)
- …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 (Lansing, MI)
- …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 (Lansing, MI)
- … 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
- CVS Health (Lansing, MI)
- …structure the group setups within the Meritain system to align with our vendor partners (PBM's, Managed Care Entities, etc..), analytics vendors ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more