- Molina Healthcare (Santa Fe, NM)
- …and monitoring claims reprocessing through resolution. **Essential Job Duties** * Serves as claims subject matter expert - using analytical skills to ... JOB DESCRIPTION **Job Summary** Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory… more
- Cardinal Health (Santa Fe, NM)
- …personnel documentation as required, necessary, or appropriate. + Acts as a subject matter expert in claims processing. + Processes claims : ... account receivables performance and client satisfaction. + Resolves complex insurance claims , including appeals and denials, to ensure timely and accurate… more
- Zurich NA (Santa Fe, NM)
- …and customers as appropriate. **Expertise, Mentorship & Continuous Learning:** + Maintain subject matter expertise and regulatory compliance by staying informed ... Senior Professional Liability Claims (Attorney), Claims Construction 129572 **Zurich North America is expanding its nationwide Construction Professional… more
- Sedgwick (Santa Fe, NM)
- …or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | General Liability BI | Captive |...General Liability BI | Captive | Remote As a Claims Examiner at Sedgwick, you'll have the opportunity to… more
- Sedgwick (Santa Fe, NM)
- …or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | Multi-Line | Public Entity | Remote...the same assisting our public entity clients with their claims ! If you are an agile multi-line examiner with… more
- Oracle (Santa Fe, NM)
- …Review, case management, and healthcare quality preferred **Responsibilities** + **Act as subject matter expert (SME):** Provide expertise for Claim ... grow your career in this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for… more
- Zurich NA (Santa Fe, NM)
- …Chemicals you will handle complex new and renewal domestic Energy accounts and serve as a Subject Matter Expert on the team. As a member of Zurich's ... and 10 or more years of experience in the Claims or Underwriting Support area OR + Zurich Certified...set at 20%. As an insurance company, Zurich is subject to 18 US Code | 1033. A future… more
- Highmark Health (Santa Fe, NM)
- …positive working relationships with internal and external customers. + Act as a resource and subject matter expert to colleagues with less experience on a ... the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the… more
- Sedgwick (Santa Fe, NM)
- …& Insurance Implementation Project Manager **PRIMARY PURPOSE** **OF THE ROLE** To serve as the subject matter expert (SME) of a single line of business; ... combination of education and experience required to include two (2) years of claims management, managed care or other related experience. **Skills & Knowledge** + In… more
- Meta (Santa Fe, NM)
- …strategic importance to Meta. The Schedule lead will act as a technical Schedule subject matter expert overseeing all schedule management and reporting for ... to site teams for Delay Tracking, EOT requests and claims . Responsible for making recommendations that are in line...or Equivalent Technical Field or related field experience 11. Subject Matter Expert in Primavera… more
- Intermountain Health (Santa Fe, NM)
- …on special projects. Trains and mentors new associates to the department. Serves as a subject matter expert and resource to answer questions within the ... for performing a variety of complex duties, including working insurance claims follow-up and escalations, interpreting contract language, and tracking trends. This… more
- Meta (Santa Fe, NM)
- …strategic importance to Meta. The Schedule Lead will act as a technical Schedule subject matter expert , overseeing all schedule management and reporting for ... to site teams for Delay Tracking, EOT requests and claims . Responsible for making recommendations that are in line...or Equivalent Technical Field or related field experience 11. Subject Matter Expertise in Primavera P6 and… more
- Molina Healthcare (Santa Fe, NM)
- …to ad-hoc data analyses, development, and presentation of financial reports. * Serves as subject matter expert on developing financial models to evaluate the ... decision-making. * Mines and manages information from large data sources. * Analyzes claims and other data sources to identify early signs of trends or other… more
- Molina Healthcare (Santa Fe, NM)
- …to ad-hoc data analyses, development, and presentation of financial reports + Serve as subject matter expert on developing financial models to evaluate the ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Humana (Santa Fe, NM)
- …responsible for supporting the Stars strategy within Insurance Operations, serving as a subject matter expert for Stars-related initiatives, and ensuring ... encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …trial design, conduct, and data interpretation. + Serve as the medical lead and subject matter expert for assigned indications. + Partner with ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Sedgwick (Santa Fe, NM)
- …or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- CVS Health (Santa Fe, NM)
- …As the Manager of Pharmacy Communications, you will serve as the main liaison and subject matter expert for all pharmacy communication needs for Elevance ... plan member disruption. Educate team members and other business partners and serve as subject matter expert on Pharmacy Communications and the supporting… more
- CVS Health (Santa Fe, NM)
- …all with heart, each and every day. **Position Summary** + Acts as an advocate and subject matter expert guiding the business by serving as a quality ... provide effective and timely support. + Acts as a subject matter expert on Quality...and decision making skills + College degree preferred + Claims experience + DG system experience **Education** + High… more
- Molina Healthcare (Santa Fe, NM)
- …issues that may cross departmental lines and involve Senior Leadership. + Serves as a subject matter expert for other departments. + Trains other Provider ... Requires an in-depth knowledge of provider services and contracting subject matter expertise. + Resolves complex provider...3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5… more