- Zurich NA (Trenton, NJ)
- 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
- AmeriHealth Caritas (Philadelphia, PA)
- … care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral ... between Plans and its' contracted or subcontracted fully delegated vendor providers for all dental-connected products, including Medicaid and...work experience. + Minimum of 3 years in the managed care /health insurance industry. + 1 to… more
- Evolent (Trenton, NJ)
- …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 (Trenton, NJ)
- …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 (Trenton, NJ)
- …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 (Trenton, NJ)
- … 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
- St. Luke's University Health Network (Allentown, PA)
- …necessity, and other requested denials as deemed clinically appropriate. + Investigates managed care and commercial insurance rejections, denials for possible ... which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses...Provides billing with information needed to obtain payment of claims . Remote within local geography after orientation. JOB DUTIES… more
- CVS Health (Blue Bell, PA)
- …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 ... accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. **Position Summary** At Aetna, our health… more