- Trustmark (Raleigh, NC)
- …the best to our colleagues, clients and communities. Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner ... in accordance and compliant with government regulations. Develops claims adjudication policies and procedures that maximize the accuracy of claims payments.… more
- Humana (Raleigh, NC)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to...member PHI / HIPAA information + This is a remote position\#LI- Remote **Scheduled Weekly Hours** 40 **Pay… more
- Merck (Raleigh, NC)
- **Job Description** **Role Summary** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who engages ... questions about Company products. The work of an Regional Medical Scientific Director is aligned to: Scientific Exchange, Research, Scientific Congress Support, and… more
- Prime Therapeutics (Raleigh, NC)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Director Account Management, PACE - Remote **Job Description** + Owns overall ... Management Centers (CMC) and Shared Services, assurance of accuracy of claims payment and administrative policies, rate maximization through ongoing benefit analysis… more
- Takeda Pharmaceuticals (Raleigh, NC)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure...around the world. This position is currently classified as " remote " in accordance with Takeda's Hybrid and Remote… more
- United Therapeutics (Raleigh, NC)
- …the pharmaceutical and biotech industry, including FDA advertising and promotion, False Claims Act, Anti-Kickback Statute, OIG Guidance, the PhRMA Code, the Sunshine ... Compliance departments related to the Food Drug and Cosmetic Act, the False Claims Act, Anti-Kickback Statute, the Sunshine Act and other healthcare related laws and… more
- IQVIA (Durham, NC)
- …capabilities to a health plan: data & analytics, interoperability, claims processing, population health.** + Exemplary interpersonal, relationship building, ... negotiations, and professional skills. + Confident, assertive, results driven, strong organizational skills and self-motivated, self-starter. + Must be self-motivated, have the internal drive to keep calling even when not getting traction immediately and have… more
- HealthEdge Software Inc (Raleigh, NC)
- **Overview** ** Director , Product Management** **Position Overview:** We are seeking a highly skilled and experienced Director of Product Management to lead our ... and QE. We have divided our product teams into Value Streams (ie, Claims , Billing & Financials, Enrollment, BlueCard, Integration, and Platform). Each Value Stream… more
- Amgen (Holly Springs, NC)
- …team. Join us and transform the lives of patients while transforming your career. ** Director , Project Controls** **What you will do** Let's do this. Let's change the ... world. In this role the Director of Project Controls will be accountable for leading,...and contractors' physical progress. + Addressing progress and delay claims from contractors + Analysis and accurate review of… more
- HomeSafe Alliance (Raleigh, NC)
- **Title:** Director of International, Global Household Goods Moving Services **_HomeSafe Alliance_** is the single global household goods movement manager of over ... the Role** HomeSafe Alliance is seeking a highly skilled and motivated Director of International, Household Goods Moving Services to drive optimization and improve… more
- Humana (Raleigh, NC)
- …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
- Prime Therapeutics (Raleigh, NC)
- …every decision we make. **Job Posting Title** Data Visualization Consultant - Remote **Job Description** The Data Visualization Consultant supports the business in ... Under general supervision, analyze or produce reports of varied claims data to assess Prime's products and/or programs; utilize...adjust focus **Reporting Structure** + Reports to Principal, Manager, Director , or Sr Director in the Health… more
- Prime Therapeutics (Raleigh, NC)
- …decision we make. **Job Posting Title** Manager, Reporting & Analytics - Remote **Job Description** The Manager, Reporting and Analytics is responsible for ... + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data...to adjust focus **Reporting Structure** + Reports to a Director or Sr Director in the Operations,… more
- Prime Therapeutics (Raleigh, NC)
- …we make. **Job Posting Title** Senior Business Integration Consultant - Remote **Job Description** The Senior Business Integration Consultant is responsible for ... efforts + Proficiency in one or more of the following areas: claims , eligibility, prior authorization, accumulators, and/or benefits + Previous PBM or healthcare… more
- Prime Therapeutics (Raleigh, NC)
- …every decision we make. **Job Posting Title** Treasury Reporting Principal - Remote **Job Description** The Treasury Analyst Principal is responsible for managing, ... Team and guidance to the Accounting, Finance, Information Technology and Claims operation functions. **Responsibilities** : + Develop, manage, and advance monthly… more
- Zurich NA (Raleigh, NC)
- …AM - Remote Work (US) Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-BN1 #LI- DIRECTOR #LI-HYBRID ... Zurich's Philadelphia office. We are also open to hiring remote talent. This role will be filled at either...and 10 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance… more
- American Institutes for Research (Chapel Hill, NC)
- …to the analysis of healthcare data and provide support to the project director and/or senior team members on various tasks including querying large datasets ... including Medicare, Medicaid, and commercial payer claims data, cleaning and imputing data, creating analytic data files according to technical specifications,… more
- SitusAMC (Raleigh, NC)
- …and leader development, policy administration and compliance with support from Director + Ensures adherence to policies and procedures regarding employee relations, ... coaching, counseling, career development, and disciplinary actions. + Handles unemployment claims ; front line benefit questions, helps leaders write or update job… more
- HomeSafe Alliance (Raleigh, NC)
- …with GHC pricing requirements and report actual performance monthly to the Director of International Operations (DIOps) + Verify and assess accuracy of transit ... risks of not meeting RDDs as directed by the Director of International Operations, for all shipments that may...International Operations, for all shipments that may create inconvenience claims for HomeSafe. Formats and data requirements to be… more
- Granville Medical Center (Oxford, NC)
- …and oral communications skills. Must have computer skills. Position will be remote after training completed. ACCOUNTABLE TO: Director , Health Information ... for interacting with the Insurance Department for timely processing of claims . Responsible for abstracting diagnoses and procedures from medical record into… more