- Prime Therapeutics (Raleigh, NC)
- …that. It fuels our passion and drives every decision we make. **Job Posting Title** Claims Lead **Job Description Summary** Adjudicate or submit claims and ... cause analysis and provide additional training as needed. Resolve claims edits and suspended claims . **Job Description**...and administrative duties as required by business need. + Lead and implement positive changes with a high level… more
- MetLife (Cary, NC)
- …* Independently manage an assigned caseload of the most complex claims which consists of pending, ongoing/active and appeal reviews. Provides timely, ... balanced and accurate claims reviews, documentation and recommended decisions in a time...information is needed to make a reasonable and logical claims determination based off the information available. Proficiently calculates… more
- Humana (Raleigh, NC)
- …of our caring community and help us put health first** The Senior Pharmacy Claims Professional adjudicates pharmacy claims and process pharmacy claims for ... data requires an in-depth evaluation of variable factors. The Senior Pharmacy Claims Professional oversees processes and ensures accuracy for pharmacy point of sale… more
- UMB Bank (Raleigh, NC)
- **Duties & Responsibilities** The Manager, Card Fraud Claims , will oversee and manage the UMB card fraud claims process, ensuring timely and accurate resolution ... of fraud cases. The role will lead a team of fraud analysts and assist in...and assist in developing strategies to mitigate card fraud claims risk. This role will also assist with the… more
- HealthEdge Software Inc (Raleigh, NC)
- …**Your Impact** **: ** + Develop the product roadmap forclaimsvalue stream and lead high-level epic planning for current and futurequarters + Lead and ... and coordinate delivery of multiple product features across multiple engineeringteams + Lead engineering grooming sessions for selected epics and stories + Work… more
- HealthEdge Software Inc (Raleigh, NC)
- …**REQUIRED HOURS: Full-time.** **REQUIRED DUTIES:** + Develop the product roadmap for claims value stream and lead high-level epic planning for current ... commercialization and organization enablement of features that the team creates. + Lead and define high-level business requirements for all assigned epics working… more
- Siemens Energy (Raleigh, NC)
- …sub supplier contracts. Work in unison with the new business unit to handle warranty claims from our customer. Lead all aspects of crafting and sharing project ... in the bid. Being the single point of contact and authorized to lead all aspects of the service agreement. Coordinate planned service activities, including… more
- Deloitte (Raleigh, NC)
- Operations Technology Transformation Manager, Guidewire PolicyCenter Configuration Technical Lead What we do Operations and Technology Transformation delivers market ... and maintain contact with top decision makers at key clients; participate and lead aspects of the proposal development process; contribute to the development of… more
- Siemens (Wendell, NC)
- …create the power distribution grid of the future. **We are looking for a Warehouse Team Lead . This position will be based at our Wendell, NC location.** As a Team ... Lead , you will manage all aspects of receiving. Our...the record of shipment, inspects condition, and files damage claims with carriers. + Records received items according to… more
- Takeda Pharmaceuticals (Raleigh, NC)
- …therapies to patients worldwide. Join Takeda as Associate Director, Global Labeling Lead where you will be responsible for the development and implementation of ... Cross-Functional Team (GLOC) + In alignment with TAU/MPD Labeling Lead , coordinates the process to obtain labeling approval by...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more
- SMX (Raleigh, NC)
- Lead Buyer (3727)at SMX(View all jobs) (https://www.smxtech.com/careers/) United States SMX is seeking a skilled ** Lead Buyer** to provide buying support for our ... order. * Negotiates and settles with vendors regarding damage claims , rejections, losses, return of materials, overages, cancellations, and...* Provides guidance to less experienced Buyers. * May lead a small team of Buyers on large programs… more
- Humana (Raleigh, NC)
- …services. **Responsibilities:** The Value-Based finance team is seeking a Financial Analytics Lead . This individual will work across the business, and will be highly ... to support critical business decisions and optimize outcomes. + Lead design and development of Power BI reporting and...to leadership. + Partner with DH&A team to evaluate claims data to drive deeper insights into the business… more
- Walmart (Raleigh, NC)
- …up orders are filled. Oversees assigned area of responsibility by handling claims and returns; zoning the area; arranging and organizing merchandise; identifying ... shrink and damages; organizing and maintaining availability of carts/flatbeds; assisting members with transporting items; utilizing cart retrieval equipment according to company policies and procedures; and maintaining parking lot cleanliness. Completes… more
- Walmart (Raleigh, NC)
- …in accordance with company policies and procedures by properly handling claims and returns; zoning the area; stocking, arranging and organizing merchandise; ... setting up, cleaning, and organizing product displays; removing damaged goods; signing and pricing merchandise according to company policies and procedures; identifying shrink and damages; and securing fragile and high-shrink merchandise. Monitors food and… more
- Sedgwick (Raleigh, NC)
- …Consultant **PRIMARY PURPOSE** **:** To manage claim caseload of highly complex claims , coverage issues (handling claims against insurance or other companies ... specific loss such as discontinuing business expense. + Handles claims of at least one million dollars and that...(ie EDI, timeliness of benefit payments, etc.); assists Team Lead in tracking completion of team's tasks and projects;… more
- Elevance Health (Cary, NC)
- …Public Policy Institute (PPI). **How you will make an impact:** + Lead and support the design and execution of pharmacoepidemiology research, including ... active monitoring studies. + Provide epidemiology subject matter expertise and lead or support research activities related to scientific study design, application… more
- Guardian Life (Raleigh, NC)
- **Job Posting Title** **Team Leader, Absence Claims Management** **Job Description** The **Team Leader, Absence Claims Management** is responsible for leading a ... submit process improvement ideas to revise workflows and procedures. + Support claims initiatives by encouraging/providing relevant feedback and acting as a change… more
- Elevance Health (Cary, NC)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... and a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Deloitte (Raleigh, NC)
- …technical expertise to deliver effective solutions to clients. You will be the lead person to interface between the clients and our Deloitte teams. You will ... requirements, design the solution, redefine the business, present the prototype, and lead the testing of our custom technology solutions. Qualifications Required +… more
- Norstella (Raleigh, NC)
- …visionary Senior Director of RWD (Real-World Data) Analytics and Innovation to lead real-world data special projects, such as building multimodal datasets, piloting ... integrating diverse data sources, including laboratory data, electronic medical records (EMR), claims data, and social determinants of health (SDoH) data, to drive… more