- Sedgwick (Minneapolis, 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
- Trustmark (St. Paul, MN)
- …and/or negotiate with claimants and legal representatives. Provides sign-off approval of highly complex or high-dollar claims . + Fosters a culture of continuous ... the best to our colleagues, clients and communities. Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner… 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)
- … 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
- Conviva (St. Paul, MN)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to … more
- AECOM (Minneapolis, MN)
- …infrastructure consulting firm, partnering with clients to solve the world's most complex challenges and build legacies for future generations. There has never been ... world. Join us. **Job Description** AECOM is seeking an experienced **Regional Director of Alternative Delivery** for this exciting opportunity to oversee the… 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)
- …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
- Air National Guard Units (Duluth, MN)
- …Responsibilities Major Duties: This is not an all-inclusive list A DIRECTOR OF INSPECTIONS, GS-1801-12Plans, organizes, resources, and directs the execution of ... a wide range of complex inspection activities for the wing Commander's Inspection Program...provide transcripts or other documentation to support your Educational claims . To receive credit for Education, you must provide… more
- Caris Life Sciences (MN)
- **Position Summary** The Director , Market Access Medical Policy is the expert in Caris Life Science Products and their clinical application for the Market Access ... internal clinical development team in order to improve product claims to obtain payer coverage. + Assist in collaborative...attentive to detail. + Ability to work in a complex and matrix team environment; experience working in a… more
- Evolent (Workman, MN)
- …health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek ... health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek… 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 (St. Paul, MN)
- …**Responsibilities** + Under general supervision, 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 + 2 years of experience working with...+ Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data… more
- Prime Therapeutics (Eagan, 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
- The Cigna Group (Bloomington, MN)
- …in over $4B of revenue annually with earnings of approximately $1B. The senior director of Stop Loss will be responsible for protecting and growing this business ... solutions that enhance affordability and improve the predictability of high-cost claims for clients. + In partnership with Cigna's Affordability, Governance, &… 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 $64,700.00… 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
- Zurich NA (Minneapolis, MN)
- …Surety Regional Leader 113231 Zurich is currently looking for a VP, Territory Director for our Commercial Surety Group in the Central Region. The Central region ... and oversight on strategic underwriting practices. The VP, Territory Director , Commercial Surety is responsible for: + Managing a...Degree with 20 or more years of experience in Claims or Underwriting Support area within the Commercial Insurance… 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