17 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...

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 Eligibility Analyst- REMOTE Job Description The Eligibility Analyst is responsible for representing commercial or government programs' eligibility and acts as a subject matter expert for department projects, Run functions and escalated client issues. This role is responsible for mentoring and training the Eligibility Specialist. Responsibilities Serves as subject matter expert representing eligibility on file process for new and existing clients and department projects; monitors eligibility mailbox and Prime Resolution daily, participates in workstream meetings, assists with providing information regarding business requirements, and performs User Acceptance Testing Serves as primary contact for external...

Your Future Evolves Here Evolent partners with 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 to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: The Performance Suite Analytics team offers candidates the opportunity to generate meaningful impact through translating disparate data points into tangible insights and actions....

Your Future Evolves Here Evolent partners with 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 to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: The Performance Suite Analytics team offers candidates the opportunity to generate meaningful impact through translating disparate data points into tangible insights and actions....

JOB REQUIREMENTS: Summary: The primary responsibility of a healthcare business analyst is to pinpoint problems or improvement areas within a medical facility in order to maximize that facility\'s performance and profit. They must assess financial activity and seek ways to manage expenses like overtime wages and the cost of supplies. Project Details: Analyzes reporting needs available data and various methods of data retrieval to develop systems which are responsive to the needs of the Department Develops and maintain production reporting capabilities Monitors the timely and accurate production and distribution of all standard and special user generated reports 3Provides support to the Utilization Management Department for personal computer usage by attending and teaching classes developing new applications and disseminating information throughout the Department. This support will be manifested in the creative use of existing software and the ongoing efforts to acquire the most...

JOB REQUIREMENTS: Summary: The primary responsibility of a healthcare business analyst is to pinpoint problems or improvement areas within a medical facility in order to maximize that facility\'s performance and profit. They must assess financial activity and seek ways to manage expenses like overtime wages and the cost of supplies. Project Details: Analyzes reporting needs available data and various methods of data retrieval to develop systems which are responsive to the needs of the Department Develops and maintain production reporting capabilities Monitors the timely and accurate production and distribution of all standard and special user generated reports 3Provides support to the Utilization Management Department for personal computer usage by attending and teaching classes developing new applications and disseminating information throughout the Department. This support will be manifested in the creative use of existing software and the ongoing efforts to acquire the most...

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option (PACE) to the most vulnerable senior population while serving as a care provider and care plan to those individuals we serve. Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and accurate pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or company policies and procedures. Essential Job Duties: Review processed claims for accuracy prior to payment while maintaining acceptable levels of claim's aged inventory by verifying various aspects of the system and claim Complete and maintain detailed documentation of audit findings which include decision methodology, system or processing errors, and monetary discrepancies Move claims free of processing errors through for full adjudication and...

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...

Business Analyst III Hybrid: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Business Analyst III is responsible for identifying, analyzing, and validating overpayment recovery opportunities, translating moderately complex and varied business needs into business cases or business requirements document (BRD) to create data mining queries that will contribute to cost of...

Oliver Wyman Actuarial Consulting, Inc. – Health Practice Job Description: Analyst Location: Hybrid; preference for Atlanta, Chicago, Milwaukee, Philadelphia, or New York, but open to other Oliver Wyman Actuarial office locations Company Overview Oliver Wyman is a global leader in management consulting and actuarial consulting. With offices in 60 cities across 29 countries, Oliver Wyman combines deep industry knowledge with specialized expertise in strategy, operations, risk management, and organization transformation. The firm has more than 5,000 professionals around the world who work with clients to optimize their business, improve their operations and risk profile, and accelerate their organizational performance to seize the most attractive opportunities. Oliver Wyman is a wholly owned subsidiary of Marsh McLennan [NYSE: MMC]. Twitter @OliverWyman. Visit our website for more details about Oliver Wyman: www.oliverwyman.com What We Do Oliver Wyman provides...

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...

Actuarial Analyst II Location: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Actuarial Analyst II completes projects and performs complex actuarial studies. How You Will Make an Impact: Primary duties may include, but are not limited to: Obtains, verifies, analyzes and models data including risk reporting and forecasting. Calculates monthly claims...

JOB REQUIREMENTS: The primary responsibility of a healthcare business analyst is to pinpoint problems or improvement areas within a medical facility in order to maximize that facility\'s performance and profit. They must assess financial activity and seek ways to manage expenses like overtime wages and the cost of supplies. Project Details: Analyzes reporting needs available data and various methods of data retrieval to develop systems which are responsive to the needs of the Department Develops and maintain production reporting capabilities Monitors the timely and accurate production and distribution of all standard and special user generated reports 3Provides support to the Utilization Management Department for personal computer usage by attending and teaching classes developing new applications and disseminating information throughout the Department. This support will be manifested in the creative use of existing software and the ongoing efforts to acquire the most cost...

JOB REQUIREMENTS: The primary responsibility of a healthcare business analyst is to pinpoint problems or improvement areas within a medical facility in order to maximize that facility\'s performance and profit. They must assess financial activity and seek ways to manage expenses like overtime wages and the cost of supplies. Project Details: Analyzes reporting needs available data and various methods of data retrieval to develop systems which are responsive to the needs of the Department Develops and maintain production reporting capabilities Monitors the timely and accurate production and distribution of all standard and special user generated reports 3Provides support to the Utilization Management Department for personal computer usage by attending and teaching classes developing new applications and disseminating information throughout the Department. This support will be manifested in the creative use of existing software and the ongoing efforts to acquire the most cost...

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...