17 general claims manager jobs found in Harrisburg

Job Description Are you a results-oriented sales specialist with a strong background in supply chain transformation? Do you have a track record of driving SaaS growth across complex sectors like healthcare, distribution, and life sciences? If so, this is your opportunity to lead strategic engagements across North America and shape the future of digital supply chains. At Oracle, we are redefining healthcare and life sciences operations through intelligent, cloud-based supply chain solutions. Oracle Supply Chain Management (SCM) Cloud connects procurement, planning, logistics, and inventory with financial and operational systems - driving efficiency, resilience, and performance. We are looking for a high-performing Supply Chain Solution Sales Specialist (SSE) to lead Oracle SCM solution sales across life sciences and pharmaceutical organizations in NA. Join us and play a key role in enabling our customers' digital future. Responsibilities Develop and execute regional...

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 Coordinator, Intake Utilization Management at Evolent will serve as a point of contact for processing prior authorization requests in accordance with departmental policies,...

As the Team Leader, LTD Claims Case Management , you will be responsible for validating that all LTD claims are accurately and fairly adjudicated according to plan provisions, established best practices and within state and federal guidelines. As the Team Leader you must be able to manage and resolve issues that pertain to claim administration procedures cost containment activities, reports and quality control issues. You will serve as primary resource for the team and provide direction to the staff members by setting objectives, communicating progress and goals, and holding the staff accountable for adhering to all quality assurance, turnaround times, best practice standards, and operational efficiency. You are also responsible for assisting staff with career development and career progression. The Team Leader partners with internal cross functional areas for program direction, goal setting, service delivery and development of action plans and leveraging bench strength. You...

Become a part of our caring community and help us put health first Encounter Data Management Professional is responsible for ensuring accurate submission and reconciliation of encounter data to Medicaid and Medicare through effective business processes. Ensures claims submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long-term improvements of claims submission processes. Takes ownership by applying professional standards, regulations, and strategies within their work area. Independently sets priorities and makes decisions on work approach while following established direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Humana's Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional that has experience with business processing and data...

Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website https://www.us.sumitomo-pharma.com or follow us on LinkedIn. Job Overview We are currently seeking a dynamic, highly motivated, and experienced individual for the position of Sales Account Manager, Oncology. In this field-based role, the Prostate Cancer Sales Specialist will focus on achieving sales goals in their assigned geographic territory. This role serves the Greater Sacramento area and the successful candidate must live within territory. This individual will...

The Manager, Manufacturing Product Quality (Small molecule) is responsible for ensuring GMP compliance in the manufacturing packaging, labeling, and distribution of commercial and clinical trial materials across global operations. This role supports the oversight of manufacturing and packaging activities performed internally and at external vendors, ensuring that quality standards are met and regulatory requirements are maintained throughout the commercial and clinical supply chains. The manager will collaborate with cross-functional teams including Clinical Operations, Regulatory Affairs, and Supply Chain to ensure the integrity and traceability of investigational products from manufacturing and packaging through delivery. Key Responsibilities Oversee manufacturing of commercial and clinical products at contract manufacturers to ensure compliance with GMP, and applicable global regulatory requirements. Performs batch record review and quality release...

Job Summary The Manager, Clinical Operations works closely with the OPDC Monitoring Oversight Lead to manage monitoring oversight activities including managing Clinical Monitoring Consultants (CMC) contracted to perform monitoring oversight duties as well as escalating issues related to CRO monitoring quality. While focusing on quality and compliance, uses metrics and key performance indicators to drive monitoring oversight activities to achieve timelines and deliverables across the portfolio. Additionally, the Manager, Clinical Operations will support planning, resourcing, contracting, and budgeting of CMC resources to conduct monitoring oversight tasks. The Manager, Clinical Operations will also coordinate reporting and review of CRO related Key Performance Indicators (KPIs) Monitoring Oversight Lead. Job Description Manage Monitoring Oversight activities in North America, and other regions as assigned With the OPDC Monitoring Oversight Lead, plan...

Job Summary The Field Force Effectiveness team at Otsuka America Pharmaceutical, Inc. plays a highly visible role in optimizing the performance of the sales and marketing efforts, for the field sales teams. As a result, Systems Training plays a key role in ensuring that the sales force understands how to effectively utilize our technology to enhance customer interactions, optimize selling opportunities and provide insight on our business processes that support our business. The Senior Manager of National Systems Training work with the field sales teams to design, develop and deliver new hire systems tech training on our InGenius (CRM System), ORION (Field Reporting) and Business Planning system across all brands. The role is also responsible or continual training on system enhancements and capabilities for the organization. In addition, the role will require system training content updates and cross collaboration between systems owners and multiple departments such as...

Job Summary Senior Manager, Digital Content and Social Strategy Position Overview The Senior Manager, Digital Content & Social Strategy is responsible for shaping and amplifying Otsuka's external digital presence across our corporate website, social platforms, and emerging digital touchpoints. This role drives integrated content strategies that elevate our corporate voice, strengthen reputation, and build advocacy for our science, our leadership, and our commitment to redefining what's possible for the people we serve. Reporting to the Director of Corporate Brand and Reputation, the Senior Manager leads corporate website governance, social media strategy, analytics, digital storytelling, and executive social programs. This professional excels at cross-functional collaboration, "story mining," and translating complex concepts into compelling, audience-centric narratives. Key Responsibilities Corporate Website Content & Governance Own content...

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 Public Consulting Group. 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. Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian...

Job Summary Within Otsuka Pharmaceutical Co. exists Otsuka Pharmaceutical Development & Commercialization, Inc. (OPDC) a U.S.A. subsidiary exists the Global Clinical Development (GCD) department. OPDC-GCD are a group of physicians and scientists who lead clinical development activities for Otsuka's global health-care products. The Global Clinical Development Program Leader is responsible for leading the end-to-end strategy, and development and delivery of a portfolio of novel serotonergic agonists (NSA). Shaping and executing late-stage clinical development strategies for the NSA portfolio of therapeutic assets, ensuring programs progress efficiently toward registration and commercialization. This role serves as the primary and single point of contact for internal and external stakeholders, ensuring seamless integration, governance, and lifecycle management from early-stage development through submission to global health authorities. This role provides scientific,...

About us: Al-Huda School PA is a private non-profit Islamic educational institution located in Camp Hill, PA. We strive to provide quality Islamic education for preschool through 6th grade. Our mission is to develop well-rounded students inspired by Islamic principles, excellent academics, and extracurricular activities, while seeking to prepare our students to live a God centered life rooted in the teachings of the Quran and authentic sunnah of Prophet Muhammad (peace be upon him). SUMMARY: The Building Manager is responsible for keeping the building and grounds in good working order as to maintain a safe, clean, and healthy environment for students, staff, and the community. Please continue reading here for full job description and qualifications. ESSENTIAL DUTIES AND RESPONSIBILITIES: The following statements of duties and responsibilities describe the general nature and level of work being performed by the leader filling this position. These statements are...

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 Mgr Reporting & Analytics - Remote Job Description The Manager Reporting and Analytics is responsible for developing strategic priorities and executing operational plans for information delivery to both internal and external customers. The position works in concert with all areas of the business to define and implement overall reporting program goals, data storage, and tasks related to scope, quality, efficiency, budget, schedule and benefit. Responsibilities Lead the development of the department reporting strategy based on compliance and regulatory needs, client demands, continuous improvement, and inter-departmental requirements Serve as mentor and manager of team of reporting; develop and coach staff...

Job Description The ideal candidate will have a strong background in cost control, contract administration, and risk management within the data center or critical infrastructure sector. Responsibilities include collaborating with cross-functional teams, monitoring project expenditures, and ensuring projects are delivered on time and within budget. The candidate will play a pivotal role in managing and controlling project costs for our data center construction and infrastructure initiatives. You will be responsible for developing and maintaining accurate project budgets, overseeing cost estimation processes, and implementing effective cost control and reporting strategies. The ideal candidate will bring extensive experience in cost management, contract administration, and risk mitigation within the data center or critical infrastructure sector. Responsibilities Review and maintain project budgets and cost forecasts throughout the project lifecycle. Monitor...

Become a part of our caring community and help us put health first The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. Where You Come In The Manager, Fraud and Waste coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and...

Position Overview The Senior Product Marketing Manager, Women's Health position is responsible for being the internal subject matter expert, leading and managing the development and execution of internal market-specific products, sales tools, and communications. This position leads product launches with a cross-functional team, proactively communicates plans/activities throughout organization and manages the product lifecycle. Company Overview At FUJIFILM Healthcare Americas Corporation, we're on a mission to innovate for a healthier world, and we need passionate, driven people like you to help us get there. Our cutting-edge healthcare solutions span diagnostic imaging, enterprise imaging, endoscopic and surgical imaging, as well as in-vitro diagnostics. But we don't stop at healthcare; our Non-Destructive Testing (NDT) team harnesses advanced radiography solutions to keep transportation infrastructure, aerospace, and oil and gas assets safe and running smoothly....

Company : Highmark Inc. Job Description : JOB SUMMARY This job supervises and coordinates the day-to-day activities of the UM Intake Coordination team. The incumbent selects, develops and continuously coaches staff to the highest levels of performance. Motivates and team builds through the creation of a work environment and conditions that contribute to highest levels of performance. ESSENTIAL RESPONSIBILITIES Perform management responsibilities including, but limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct, and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. Determine workflow for the day and assign work to the team.Monitor and manage daily inventories to ensure adequate staffing and resources are...