- Sedgwick (Portland, ME)
- …place to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer ( Remote ) Claims Compliance Manager - Workers Compensation | ... issues or enhancements to the current systems. + Identifies and requests appropriate claims management system enhancements to improve compliance . + Acts as… more
- Elevance Health (South Portland, ME)
- …associated with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies ... business** _Location: This position will work a hybrid model ( remote and office). The ideal candidate will live within...prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses… more
- Elevance Health (South Portland, ME)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and ... Abuse** **Location:** This position will work a hybrid model ( remote and office). The ideal candidate will live within...prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new… more
- Elevance Health (South Portland, ME)
- …Cost of Care Consultant Senior** **Location:** This position will work a hybrid model ( remote and in office one day per week). Ideal candidates will live within 50 ... Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider… more
- Elevance Health (South Portland, ME)
- …bonus for this position.** **Location:** This position will work a hybrid I model ( remote and in office 1-2 days per week). Candidates must live within 50 miles ... will make an impact:** * Focuses efforts on lowering claims costs, improving the quality of care, and increasing...Uses analytic tools to track both health risks and compliance , as well as supporting the contract negotiation process.… more