- Sedgwick (Milwaukee, WI)
- …place to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Director - Complex Claims **PRIMARY PURPOSE** **:** To be ... responsible for the day to day activities of the complex claims unit, to assess the work done by the unit, and develop and improve the individuals within the… more
- Trustmark (Madison, WI)
- …and/or negotiate with claimants and legal representatives. Provides sign-off approval of highly complex or high-dollar claims . + Fosters a culture of continuous ... the best to our colleagues, clients and communities. Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner… more
- Humana (Madison, WI)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Humana (Madison, WI)
- …of our dynamic Wisconsin leadership team in this position as the Director , Consumer Service Operations. This position works with insurance companies, providers, ... members, and collection services in the settlement of claims through Call Center operations. Comprised of a team of claims associates researching & resolving the… more
- Humana (Madison, WI)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... The Medical Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records,… more
- Humana (Madison, WI)
- …relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation and… more
- Molina Healthcare (Kenosha, WI)
- …years leadership/supervisory experience required * Progressive management experience to manage complex work systems and workflows required * Knowledge of pre-edit ... Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid,… more
- Molina Healthcare (WI)
- …* Provides assessments and business rules to Corporate Configuration for COB tables and Claims edits logic in the QNXT system as well as maintenance to the internal ... databases._** + Proven success managing initiatives with multiple stakeholders and complex workflows. To all current Molina employees: If you are interested… more
- Prime Therapeutics (Madison, WI)
- …or enhanced financial pricing strategies. This position will also lead highly complex financial pricing analyses, and provide consultation and analytic insight to ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more
- Zurich NA (Madison, WI)
- …Liability Underwriter, (Sr. Level III or AVP Level IV) you will handle complex new and renewal domestic Construction Professional Liability accounts and serve as a ... Diploma or Equivalent and 10 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance Apprentice including an Associate… more
- Mathematica (Madison, WI)
- …data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and ... and Mathematica's contractual and regulatory requirements. * Act as Project Director on select awarded projects, ensuring successful execution from kickoff through… more
- Prime Therapeutics (Madison, WI)
- …Evaluates the utilization and financial experience of customers and prospects + Performs claims re-pricing analyses of moderately complex external claims ... and ability to adjust focus **Reporting Structure** + Reports to Manager or Director in the Finance Department Potential pay for this position ranges from $59,000.00… more
- Prime Therapeutics (Madison, WI)
- …The Senior Business Integration Consultant is responsible for leading multiple complex small to mid-sized client and/or product implementations, projects, analysis, ... and external leaders + Ability and desire to drive solutions for complex business needs (including operational and technical aspects) + Familiarity with project… more
- Zurich NA (Milwaukee, WI)
- …Surety Regional Leader 113231 Zurich is currently looking for a VP, Territory Director for our Commercial Surety Group in the Central Region. The Central region ... and oversight on strategic underwriting practices. The VP, Territory Director , Commercial Surety is responsible for: + Managing a...Degree with 20 or more years of experience in Claims or Underwriting Support area within the Commercial Insurance… more
- Centers for Independence (Madison, WI)
- …and treatment plan addendums + Monitors client's Prior Authorization status submits new claims as necessary and responds to member's insurance providers as needed to ... and Families and Youngstar. + Assumes responsibility for the director in the absence of the director ....groups. + Partners with clients to identify and resolve complex or sensitive issues. + Helps create a work… more
- Prime Therapeutics (Madison, WI)
- …You would be tasked with helping to develop, build and manage complex clinical product initiatives.** The Principal Clinical Program Pharmacist is responsible for ... as established. **Responsibilities** + Understand, develop, build and manage complex clinical product initiatives including clinical criteria and associated data… more
- Prime Therapeutics (Madison, WI)
- …**Preferred Qualifications** + PBM (Pharmacy Benefit Management) experience + Experience conducting complex analysis on large sets of pharmacy, claims , medical, ... analysts + Develop analytic methodologies, models, reports and new products + Lead complex client analytical work efforts and serve as an internal subject matter… more
- Evolent (Madison, WI)
- …health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek ... plans and providers to achieve better outcomes for people with the most complex and costly health conditions. Working across specialties and primary care, we seek… more
- Evolent (Madison, WI)
- …health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek ... Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. **What You Will Be Doing:** + Reviewing… more
- Prime Therapeutics (Madison, WI)
- …is responsible for managing, analyzing, and delivering Treasury reporting, including complex liquidity reporting and claim payment process reporting for a variety ... Team and guidance to the Accounting, Finance, Information Technology and Claims operation functions. **Responsibilities** : + Develop, manage, and advance monthly… more