- Travelers Insurance Company (Lake Oswego, OR)
- …$99,700.00 - $164,500.00 **Target Openings** 1 **What Is the Opportunity?** As a Manager , Compliance you will be responsible for oversight and implementation of ... compliance trends. + Advise and consult on compliance -related data and trends. + Regulatory Change...communication of new or revised laws, regulations, bulletins, and regulatory publications applicable to Property and Casualty Claim… more
- UMB Bank (Salem, OR)
- **Duties & Responsibilities** The Manager , Card Fraud Claims , will oversee and manage the UMB card fraud claims process, ensuring timely and accurate ... with the oversight and management of third-party card fraud claim vendors and ongoing card fraud claims ...UMB and vendor performance and adherence to the applicable regulatory requirements governing fraud claims for cards.… more
- Providence (OR)
- …we must empower them.** **Providence is calling a Sr. Medical Malpractice Claims Manager - Professional Liability who will:** **Investigate, Evaluate, and ... take proper steps to pay vendors + Inform Senior Manager Operations of large or complex claims ...with potential excess exposure to excess insurers + Ensure compliance with relevant claims reporting procedures and… more
- CareOregon (Portland, OR)
- …Nevada, Texas, Montana, or Wisconsin. Position Title: Claims Examiner II Department: Claims and Member Services Title of Manager : Claims Supervisor ... adjust/correct, claims including some complex and difficult claims , in accordance and/or compliance with plan...process refunds which may result in posting refunds and claim adjustments or re-adjudication. + Utilize claims … more
- Takeda Pharmaceuticals (Salem, OR)
- …CCDS, USPI and EU SmPC enabling the most up-to-date information and in compliance with labeling requirements to be provided to patients and Health Care Providers ... negotiations with Health Authorities. + Ensures labeling content conform to regulatory requirements. Management of Local Exceptions and LOC Interactions + Manages… more
- Prime Therapeutics (Salem, OR)
- …of claims , educating Prime's network pharmacies and driving contract compliance , and supporting downstream claim corrections to eliminate potential waste. ... potential pharmacies to include in onsite trips considering such information as claim analytic data, prior audit history, and/or referrals, and submit recommended… more
- CareOregon (Portland, OR)
- …and operational oversight of the dental network; access management and network adequacy; regulatory and compliance functions; and participation in state or local ... Job Title Operations Manager - CareOregon Dental Exemption Status Exempt Management...related to referral and authorization, queue management, and related compliance and regulatory requirements. Analyze, recommend, and… more
- Trinity Health (Baker City, OR)
- …routine issues and escalates to Supervisor, Patient Access. + Processes insurance claim forms. + Reviews claims /accounts for complete information, corrects and ... information and translates data into information acceptable to the claims processing system. + Prepares claims for...a point of contact for assigned payers. + Maintains compliance with HIPAA and other regulatory requirements… more
- Sumitomo Pharma (Salem, OR)
- …employee encounters is considered confidential. ** Compliance ** :Achieve and maintain Compliance with all applicable regulatory , legal and operational rules ... **Title: Sr. Manager , Medicaid Contract Administration** **Location: Remote/occasional onsite (if local to MA). Flexible work/life balance.** Sumitomo Pharma America… more
- Deloitte (Portland, OR)
- …with a well-respected team of proven innovators! Work you'll do: As a Manager , you will identify eligible federal C&I generating activities and manage and facilitate ... areas or complete the paperwork required to file a claim . You will work with an experienced and passionate...identify process improvements and opportunities for new services. The Manager will ensure accurate, timely completion of deliverables. The… more
- Walgreens (La Pine, OR)
- …others accountable for efficient workflow. + At the direction of the Pharmacy Manager or pharmacist, prepares, and files reports and records required by the company ... the direction of the pharmacist, exercises independent judgment to ensure compliance and execution of all business administrative activities and pharmacy inventory… more
- EMCOR Group (Portland, OR)
- …by ensuring that appropriate procedures and controls are in place to maintain compliance with GAAP, SEC, company and corporate reporting requirements. The Finance & ... financial controls, and records meet all federal, state, local and company regulatory requirements. + Partner with Estimating in the preparation of pre-qualification… more
- Providence (OR)
- …we must empower them._** **Providence Health Plan is calling a Product Benefits Manager who will:** + Be accountable for Providence Health Plan's detailed benefits ... Clearly defining product requirements + Prepare benefit plan documentation to support regulatory filing + Create and distribute the benefit summaries and related… more
- HealthEdge Software Inc (Salem, OR)
- …solutions suite includes the industry's leading, digital, next-generation claims administration processing system, business intelligence, integration capabilities, a ... enables our customers to react swiftly to the latest regulatory shifts and competitive pressures. It opens the door...to perform the essential functions of this position_ _in compliance with the Americans with Disabilities Act of 1990._… more
- CareOregon (Portland, OR)
- …Job Title Medicare Encounter Data Analyst Exemption Status Exempt Department Finance Manager Title Risk Adjustment Manager Direct Reports n/a Requisition # ... Using SQL and SAS programs, monitor submissions of core claims and supplemental data and reconcile against CMS response...lead the updating of business rules in response to regulatory changes. + Lead and manage the standardization and… more
- Sedgwick (Salem, OR)
- …perspective; assists sales process/customer tours as necessary. + Works with program manager , claims unit, expense bill reviewers to resolve questions, redesign ... university preferred. **Experience** Six (6) years of experience in workers compensation claims processes with experience in state regulatory issues for payment… more
- CareOregon (Portland, OR)
- …appropriate GL support. + Review and analyze data to ensure accuracy and regulatory compliance ; make or coordinate corrections as needed. + Prepare advanced ... 3006 - Finance Exemption Status Exempt Requisition # 24296 Direct Reports n/a Manager Title Accounting Operations Manager Pay & Benefits Estimated hiring range… more
- CareOregon (Portland, OR)
- …Title Data Science Analyst III Exemption Status Exempt Department Business Intelligence Manager Title Healthcare Analyst Manager Direct Reports n/a Requisition # ... data products to facilitate production of insights from healthcare claims , enrollment, and other related data. The core function...in the development of reporting tools to comply with regulatory reporting requirements. + Lead in the review and… more
- CareOregon (Portland, OR)
- …Title Healthcare Analyst Exemption Status Exempt Department Informatics & Evaluation Manager Title Director, Data Science, and Informatics Direct Reports n/a ... position is responsible for performing complex research and analysis of healthcare claims , enrollment, and other related data to provide advanced analytics and… more
- Highmark Health (Salem, OR)
- …analysis, and incurred but not recorded reserve decision making. + Oversees compliance matters including product filings, resolution of regulatory issues, ... marketed across the United States. Provides counseling/advice with respect to regulatory developments in the external environment, product development issues, and… more