- Molina Healthcare (Phoenix, AZ)
- …including accurate and timely implementation and maintenance of critical information on claims databases. Validate data to be housed on databases and ensure ... knowledge/skills/abilities:** * Establishes and maintains benefits, provider contracts, fee schedules, claims edits, and other system settings in the claim payment… more
- Humana (Phoenix, AZ)
- …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 (Phoenix, AZ)
- … 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
- Humana (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …part of our caring community and help us put health first** The Director , Medicaid Trend Mitigation Strategy provides data-based strategic direction to identify and ... planning support for business segments or the company at large. The Director , Medicaid Trend Mitigation Strategy requires an in-depth understanding of how… more
- Dignity Health (Phoenix, AZ)
- …St. Joseph's is considered a sought-after destination hospital for treating the most complex cases from throughout the world. Every day, approximately 20 percent of ... proud_ _to be_ _a tobacco-free campus._ **Responsibilities** **Job Summary:** The Market Director of Revenue Cycle reports directly to the Region Vice President of… more
- Celestica (Phoenix, AZ)
- …Supply Chain Management (SCM) **Career Stream:** Supply Chain Management (SCM) **Role:** Director 1 (DR1) **Job Title:** Director , Strategic Supply Chain ... dynamic market environment. **Detailed Description** We are currently seeking a ** Director , Strategic Supply Chain Management (Capital Equipment)** to join our team… more
- The Cigna Group (Scottsdale, AZ)
- …to in-person meetings with Providers AND several days work at Home_** The ** Director , Provider Contracting Network Management** serves as an integral member of the ... for a local given territory. **DUTIES AND RESPONSIBILITIES** + Manages complex contracting and negotiations for fee for service and value-based reimbursements… more
- Nammo Defense Systems, Inc (Mesa, AZ)
- Nammo Defense Systems seeks an experienced accountable, action-oriented, and collaborative Director of Programs with a strong background in both Contract Management ... The ideal candidate will bring proven expertise in overseeing complex defense and commercial contracts and possess a strategic...production programs. How you will be rewarded as a Director of Programs * Medical, dental, vision, STD. LTD,… more
- Humana (Phoenix, AZ)
- …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
- Merck (Phoenix, AZ)
- **Job Description** The Associate Director Data Science will be responsible for developing and communicating data-driven and actionable insights that drive greater ... analyze data leveraging advanced analytical/statistical techniques from disparate databases/sources ( claims data/EMR Data and other sources) to drive optimization… more
- Molina Healthcare (Phoenix, AZ)
- …years leadership/supervisory experience required * Progressive management experience to manage complex work systems and workflows required * Knowledge of pre-edit ... Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid,… more
- Zurich NA (Phoenix, AZ)
- …+ Understands, analyzes, and applies the component parts of an insurance policy for complex claims . + Ability to follow reserving process for indemnity and ... expense in analyzing the potential exposure of complex claims . + Ability to determine the...Remote Work (US) Remote Working: Yes Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-LC1 #LI- DIRECTOR … more
- Prime Therapeutics (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …new product development. **Responsibilities** + 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 + 3 years of experience with dashboard...+ Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data… more
- Zurich NA (Phoenix, AZ)
- …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
- Prime Therapeutics (Phoenix, AZ)
- …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
- Stantec (Chandler, AZ)
- …with Earned Value management and forecasting. + Experience with scheduling large, complex projects. + Experience with claims management for design projects. ... be based on Project/Client needs as well as proactive Claims /Risk mitigation. + Oversee and approve the development and...(PGC) Monthly Reports; issue following review with the Design Director . + Responsible for the formulation of the Project… more
- Mathematica (Phoenix, AZ)
- …data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and ... and Mathematica's contractual and regulatory requirements. * Act as Project Director on select awarded projects, ensuring successful execution from kickoff through… more
- Prime Therapeutics (Phoenix, AZ)
- …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 $59,000.00… more