- Humana (Nashville, TN)
- …level by driving real impact and shaping the future of claims management? As a Senior Pharmacy Claims Professional , you will play a pivotal role in ... and take the lead on building solutions that make a difference! The Senior Pharmacy Claims Professional analyzes and answers inquiries regarding… more
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Senior Pharmacy Claims Professional adjudicates pharmacy claims and ... process pharmacy claims for payment. The Senior Pharmacy Claims Professional work assignments involve moderately complex to complex issues where… more
- HCA Healthcare (Nashville, TN)
- …employee benefit consulting firm with a focus on pharmacy benefit and/or a senior benefit professional at a large company + Project management experience + ... like you to be a part of our team. **Job Summary and Qualifications** The Senior Pharmacy Benefit Account Manager (AM) serves as the principle liaison with small… more
- Elevance Health (Nashville, TN)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . **How will you make an impact:** + Claim… more
- Humana (Nashville, TN)
- …informaticists to define various clinical concepts and extract clinical information from medical, pharmacy , and lab claims for analytics and modeling purposes + ... + Healthcare or managed care working experience + Experience working with medical, pharmacy , lab claims + Experience working with big data and using… more
- Elevance Health (Nashville, TN)
- …and use of proprietary data and claims systems for review of facility, professional , and pharmacy claims . + Responsible for identifying and developing ... healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding,… more
- The Cigna Group (Nashville, TN)
- …through which associates complete impactful, business-critical roles while receiving professional development opportunities and career coaching. The MCLDP provides ... these rotational experiences, the program will provide you with professional development opportunities, leadership experiences, career coaching, networking and… more
- CenterWell (Nashville, TN)
- …for the following: clinical and survey metrics, clinical operations metrics, claims denials, AO/state survey results, risk mitigation, clinical compliance, QAPI ... at the center. As the nation's largest provider of senior -focused primary care, one of the largest providers of...largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health… more