- Prime Therapeutics (Columbia, SC)
- …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
- Humana (Columbia, SC)
- …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
- Humana (Columbia, SC)
- …career to the next level by driving real impact and shaping the future of claims management? As a Senior Pharmacy Claims Professional, you will play a pivotal ... perfect opportunity for you to drive your career forward. Join us and take the lead on building solutions that make a difference! The Senior Pharmacy Claims … more
- HealthEdge Software Inc (Columbia, SC)
- …**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 (Columbia, SC)
- …**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
- Norstella (Columbia, SC)
- RWD Analytics Lead - Healthcare & Life Sciences Company: Citeline Location: Remote, United States Date Posted: Sep 18, 2024 Employment Type: Full Time Job ID: R-408 ... Role:** We are seeking a dynamic and visionary RWD (Real-World Data) Analytics Lead to guide real-world data special projects, such as building multimodal datasets,… more
- Humana (Columbia, SC)
- …reducing unnecessary costs from the healthcare system. The Utilization Management Strategy Lead role works closely with internal and external stakeholders, such as ... these outcomes while driving operating efficiency. The Utilization Management Strategy Lead will bring deep expertise in utilization management (ie, across… more
- Takeda Pharmaceuticals (Columbia, SC)
- …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 (Columbia, SC)
- 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 (Columbia, SC)
- …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 (Columbia, SC)
- …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 (Columbia, SC)
- …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 (Columbia, SC)
- …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
- Guardian Life (Columbia, SC)
- **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
- UNUM (Columbia, SC)
- …with key initiative leaders and by applying agile methodology. The incumbent will lead a team that is responsible for the design and implementation of (continuous) ... (eg Global Services (IT), members of the sales organization, administration, marketing, claims and underwriting) in ensuring that the design and development of our… more
- CVS Health (Columbia, SC)
- …and interprets medical policies and procedures, including service authorization, claims review, discharge planning, and medical reviews performed through the ... administration of all medical management activities of the aligned Plans. + Plays a lead role in monitoring the overall safety of members with complex and or… more
- HealthEdge Software Inc (Columbia, SC)
- …root-cause issues areidentifiedand addressed upstream, and all aspects of claims operations are centralized for comprehensive business intelligence. The complete ... + Serve as escalation point for critical client needs aswarranted. + Lead diagnosis and resolution of escalated and more involved/complex client problems and… more
- Prime Therapeutics (Columbia, SC)
- …a high level of quality. This position has the responsibility to participate and/or lead in defining the issues to be studied as well as the methodology to ... Description** + Performs exploratory data analysis and data mining of healthcare claims and authorizations data. + Designs, documents, develops and rolls out… more
- Prime Therapeutics (Columbia, SC)
- …software to solve analytic problems + Demonstrated influencing skills with the ability to lead and drive change + Proven ability in building a trusting and safe ... platforms and products + Experience using queries, thorough understanding of pharmaceutical claims data and general understanding of medical claims data; highly… more
- J&J Family of Companies (Columbia, SC)
- …learning algorithms to analyze large-scale healthcare datasets, including HER/EMR and claims data. * **Predictive Modeling & Forecasting:** Design, implement, and ... to foster a team culture of excellence, collaboration, and innovation. Inspire and lead by example, demonstrating commitment and initiative in all aspects of your… more