15 general claims manager jobs found

At Otsuka our mission is to create new products for better health worldwide. Our purpose is to defy limitation so that others can too. In this exciting role, as a Sr. Analyst within OAPI supply chain team, you will work cross-functionally across various departments to support implementation of the S&OP (Sales & Operations Planning) process. You will assist in managing a complex portfolio of products with competing priorities that include balancing inventory, managing vendor / supplier relationships, optimizing total delivered cost to meet finished goods demand with focus on delivering value to our patients, our suppliers, and to Otsuka. You will create an environment for proactive communications with cross functional collaborators that will help ensure both internal and external customer demands are consistently met with no laps in supply and availability of products to our patients. Additional facets of the role include coordinating purchase requisitions in the...

The Manager, Data Analytics is an important role within the Medical Excellence & Operations team within Global Medical Affairs. This role will serve as the data and analytics lead supporting operational excellence across the Global Medical Affairs organization. This role is responsible for collecting, analyzing, and translating data into actionable insights that inform medical strategy, field engagement, performance measurement and medical strategy. The Manager, Data Analytics will work closely with both Field Medical and Headquarters teams to understand business needs and system requirements, support development of analytical solutions and other projects to drive key business processes and decisions for the Medical Affairs function. This role reports into the Business Solutions & Analytics Lead who reports into the Executive Director, Medical Excellence and Operations. Job Description Key Responsibilities: Data Collection, Management and Governance...

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title IT Analyst Job Description The IT Business Systems Analyst is responsible for solving moderately complex system problems and for utilizing Software Development Life Cycle (SDLC) methodology employed by Prime and partnering with the business, IT, and other project stakeholders to elicit, define, and document the requirements and technical solutions for changes to Prime's claims systems. Responsibilities Ensure understanding of business requirements and IT Business Requirement Specification acceptance criteria is successfully met prior to sign-off; identify and document system enhancement scope for assigned project Provide work plan and detailed estimate, based on scope; drive scope management, prioritization...

Job Description As part of the Network Services team within Oracle's Global Information Technology organization, you will be responsible for the delivery of IT services to Oracle's businesses worldwide, these services include the management and delivery of network infrastructure. Responsibilities Maintain records of equipment failure and liaise with engineers and suppliers as necessary. Escalate client problems according to established procedures. Manage the network using network management tools, analyze network performance and recommend network enhancements. Analyze network performance to ensure adequate bandwidth for business needs. Recommend enhancements to the network infrastructure, and with management agreement enhance proactive network management tool set. Troubleshoot network problems on the campus network, remote locations and country wide area network though to resolution. Perform Project Engineering including specification definition, design of solution in...

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Treasury Analyst Sr - Remote Job Description The Senior Treasury Analyst is responsible for working across the Finance team on the implementation and shared support of daily company cash operations, and develops cash forecast and investment strategy and provides key financial analysis on the consolidated cash flow forecast and investment portfolio. This role is responsible for providing leadership to the other members of the Treasury Team and guidance to the Accounting, Finance, Information Technology and Claims operation functions, as well as Pharmacy Networks and Government Programs. This position is also responsible for creating, developing and implementing strong controls and performing complete and accurate complex in...

About Global Atlantic Global Atlantic is a leading provider of retirement security and investment solutions with operations in the U.S., Bermuda, and Japan. As a wholly-owned subsidiary of KKR (NYSE: KKR), a leading global investment firm, Global Atlantic combines deep insurance expertise with KKR’s powerful investment capabilities to deliver long-term financial security for millions of individuals worldwide. With a broad suite of annuity, preneed life insurance, reinsurance, and investment solutions, Global Atlantic, through its issuing companies, helps people achieve their financial goals with confidence. For more information, please visit www.globalatlantic.com. Team Overview Global Atlantic / KKR Insurance Global Data Operations team is responsible for collecting, managing, and harnessing the power of data across our diverse business activities. To support the rapid growth of our insurance segment, we have established a dedicated Insurance Data Operations team . This...

Job Description This role is responsible for the design, implementation, support and maintenance of Oracle Health's Microsoft Active Directory infrastructure, DNS and associated infrastructure platforms. This role provides support, testing and monitoring of Microsoft Active Directory services and requisite services through adherence to best practices, the execution and development of automation tools utilizing PowerShell and collaboration across the Organization Key Activities Perform daily system operations tasks across multiple Active Directory forests/domains to verify system integrity and availability Perform ongoing performance tuning of Directory Services, upgrades, and resource optimization Utilize SCOM to monitor Active Directory and Windows-based servers; respond to alarms in a timely manner, preventing client impact and performance degradation Core Networking and DNS principles. Microsoft Configuration Manager Coordinate...

About Global Atlantic Global Atlantic is a leading provider of retirement security and investment solutions with operations in the U.S., Bermuda, and Japan. As a wholly-owned subsidiary of KKR (NYSE: KKR), a leading global investment firm, Global Atlantic combines deep insurance expertise with KKR's powerful investment capabilities to deliver long-term financial security for millions of individuals worldwide. With a broad suite of annuity, preneed life insurance, reinsurance, and investment solutions, Global Atlantic, through its issuing companies, helps people achieve their financial goals with confidence. For more information, please visit www.globalatlantic.com. Team Overview Global Atlantic / KKR Insurance Global Data Operations team is responsible for collecting, managing, and harnessing the power of data across our diverse business activities. To support the rapid growth of our insurance segment, we have established a dedicated Insurance Data Operations team...

Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Beth Israel Lahey Health. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Reporting to the Executive Director of Epic Patient Financial Services – PB, the Senior Epic Operations Analyst serves as the preeminent Epic analytical resource tasked with improving revenue results and operational efficiencies for all One BILH Epic Professional Billing Revenue Cycle entities. Due to its unique involvement across a wide scope of...

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. ESSENTIAL RESPONSIBILITIES Processes daily incoming Stop Loss claims including...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Prime Therapeutics. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Clinical Research Analyst, Senior - Remote Job Description The Senior Clinical Research Analyst works closely with Prime's Health Outcomes Research team to lead clinical research projects that measure, and report outcomes...

Company : United Concordia Dental Job Description : JOB SUMMARY This job provides account support activities associated with the implementation and administration of groups and accounts. Provides assistance with non-standard benefit implementation tasks. Identifies and resolves problems related to benefit interpretations, non- standard benefits, handle rating concerns, and coordinate claim extracts and any subsequent adjudication requirements. The incumbent may have direct interaction with producers, clients and sales reps to ensure complete implementation, on-going service and all renewal activity. The incumbent is new to the role and is developing competence in performing work assignments. ESSENTIAL RESPONSIBILITIES Load and maintain group information and benefit files. Interact and provide support activities to Account Managers (For UCD: Accounts Support Analysts are account managers for all small market clients. May also be involved with managing...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides account support activities associated with the implementation and administration of groups and accounts. Provides assistance with non-standard benefit implementation tasks. Identifies and resolves problems related to benefit interpretations, non- standard benefits, handle rating concerns, and coordinate claim extracts and any subsequent adjudication requirements. The incumbent may have direct interaction with producers, clients and sales reps to ensure complete implementation, on-going service and all renewal activity. The incumbent has foundational knowledge and experience, is building higher-level knowledge and skills, and makes independent contributions to projects. ESSENTIAL RESPONSIBILITIES Load and maintain group information and benefit files. Interact and provide support activities to Account Managers (For UCD: Accounts Support Analysts are account managers for all small...

Company : Highmark Inc. Job Description : JOB SUMMARY HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. This job collects, validates, analyzes, and organizes data into meaningful computerized reports by manipulating and extracting data to meet customer needs, generates reports through mainframe and/or PC applications by utilizing established applications/programs or developing new applications/programs, develops work plans to meet deadlines, accurately estimating completion dates and communicating report status to customers and management, and resolves business problems related to automated systems and provide data analysis and recommend...