23 general claims manager jobs found in Springfield

The Global Quality Audit Manager is responsible for planning, executing, and reporting on global audits to ensure Good Clinical Practice (GCP) compliance across Contract Research Organizations (CROs), clinical laboratories, and clinical investigator sites. This role plays a critical part in maintaining the integrity of clinical trial data and ensuring patient safety by verifying adherence to regulatory requirements and internal standards. As a key member of the Global Quality Management team, the Audit Manager will collaborate with cross-functional stakeholders to identify risks, drive continuous improvement, and support inspection readiness across the clinical research landscape. Key Responsibilities Audit Execution : Plan, conduct, and report GCP audits of CROs, clinical laboratories, and investigator sites globally, ensuring compliance with ICH-GCP, local regulations, and company policies. Provide oversight to contract and consultant resources in audit...

Job Summary The Senior Manager of Global Quality Management (GQM) supports the execution of clinical quality activities to ensure compliance with Good Clinical Practice (GCP), regulatory requirements, and internal standards across global clinical trials. This role provides hands-on quality oversight, supports audit and inspection readiness, and collaborates with internal teams and external partners to maintain high-quality standards throughout the clinical development lifecycle. Key Responsibilities Clinical Study Support Serve as a GCP quality resource to clinical teams during study planning, conduct, and close-out. Support the review of study documents (e.g., protocols, monitoring plans, vendor agreements) for quality and compliance. Assist in identifying and resolving quality issues, protocol deviations, and potential noncompliance. Collaborate with Clinical Operations, Regulatory Affairs, and Medical Affairs to embed quality practices...

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...

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 Network Management Consultant - Remote Job Description The Network Management Consultant is responsible for development, performance and management of Prime's retail, mail, specialty, and quality-based networks aligning with Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies. This includes development of network contracts, participation requirements, analysis of pharmacies, and ensuring contract and regulatory compliance. This position is accountable for creation and management of specialty fee schedules to ensure competitiveness and serves as the liaison between Prime's Network Management and Specialty teams. Responsibilities Negotiate market competitive high-profile and/or complex...

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...

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 Georgia Medicaid Clinical Account Manager - Remote Job Description Innovative business clinician accountable for building and maintaining customer relationships as well as leadership of the account teams within all assigned accounts. Charged with delivering results that demonstrate value to the customer, derived from identifying, demonstrating and selling valued pharmaceutical care and cost solutions that meet the desired outcomes of the customer; general management of the account, including P&L responsibility; and accountability for contract compliance.Accountable for developing and executing the strategic plan for their accounts in conjunction with sales and operations. Responsibilities Performs customer...

The Manager, Contracts (Non-HCP SOWs) is an important role within the Medical Excellence & Operations team within Global Medical Affairs. This role is responsible for end-to-end management of contracts that support Global Medical Affairs operations, excluding those with healthcare professionals or organizations. This includes agreements with vendors, consultants, technology platforms, contract research organizations (CROs), publication and medical education vendors, and other third-party service providers. This role will support the Global Medical Affairs team to ensure efficient operations, compliant contracting that align with global and regional regulations, Otsuka policies and GMA goals. This role reports directly into the Vendor Contracts and Management Lead who reports into the Executive Director, Medical Excellence and Operations. Job Description Key Responsibilities Include: Contract Development and Management Expertise Lead drafting, reviewing,...

The Senior Manager, Centers of Excellence (CoEs) is responsible for establishing, leading, and optimizing one or more prioritized CoEs within the Global Quality Operations organization-such as Inspection Readiness, Audit Effectiveness, or other strategic focus areas. This role drives execution of CoE initiatives, develops tools and frameworks, and delivers performance metrics and dashboards to support continuous improvement and operational excellence. The ideal candidate will have strong global collaboration skills and experience working across cross-functional teams in a matrixed environment. Key Responsibilities Centers of Excellence Leadership Lead the development and execution of one or more CoEs (e.g., Inspection Readiness, Audit Effectiveness) aligned with global quality priorities. Establish CoE charters, operating models, and governance structures to ensure clarity and accountability. Develop and maintain tools, templates, and guidance documents...

The Manager, Global Product Quality - Clinical Packaging is responsible for ensuring GMP and GCP compliance in the packaging, labeling, and distribution of clinical trial materials across global operations. This role supports the oversight of clinical packaging activities performed internally and at external vendors, ensuring that quality standards are met and regulatory requirements are maintained throughout the clinical supply chain. 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 packaging through delivery. Key Responsibilities Oversee clinical packaging operations to ensure compliance with GMP, GCP, and applicable global regulatory requirements. In collaboration with the supplier quality team, support qualification and monitoring of external clinical packaging vendors, including audits and performance...

The Manager, Global Product Quality - Controlled Substances is responsible for ensuring that all activities related to controlled substances across the product lifecycle meet Good Manufacturing Practices (GMP) and comply with global regulatory requirements, including DEA regulations. This role partners closely with R&D, Supply Chain, Product Development, and Warehousing & Distribution teams to ensure robust quality oversight and regulatory compliance in the handling, storage, manufacturing, and distribution of controlled substances. Key Responsibilities Product Oversight: Provide GMP oversight and guidance during the drug development process including review and approval of documentation and collaboration and oversight of suppliers/contract manufacturers. Act as a liaison with regulatory agencies and internal compliance teams regarding controlled substance matters. Quality & Compliance:Serve as the quality and compliance lead for controlled...

Job Summary The Manager, HCP Engagement Lead is a dedicated execution role responsible for the day-to-day operation and administration of the R&D Healthcare Professional (HCP) engagement and contracting process. This position is the primary point of contact for internal stakeholders seeking to engage external experts and is accountable for ensuring all contracts, payments, and documentation are processed efficiently, compliantly, and in accordance with the CoE's established "white glove" service standards. This role supports the Associate Director in maintaining the integrity of the centralized system and achieving audit-readiness. This position reports directly to the Associate Director, R&D HCP Engagement Center of Excellence (CoE). Job Description Key Responsibilities Include: Operational Execution and Contract Management Execute the end-to-end HCP contracting workflow, including drafting agreements, securing internal approvals, and managing...

Job Summary The Manager, LMS Operations & Administration position works as part of the U.S. Ethics & Compliance Training & Documentation team to lead all components of our Learning Management System (LMS) including all non-GxP assignments and audience management, curriculum management, reporting, and tier one trouble shooting. The Manager, LMS Operations & Administration will partner with all levels of Management in both business and technology groups to advance and deliver a variety of planned and ad-hoc training initiatives. This position will have direct oversight of two Contracted Workers. Job Description Responsible for the operational oversight of all LMS activities including but not limited to: Partner with internal LMS Support Team to perform needs assessments and analysis on platform operations to ensure organizational needs are being met. Leads the incorporation, socialization, and training of resulting LMS improvements. Owns...

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...

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 CVS 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. At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And...

Reference #: 1253561601 Requisition ID:903036 Position:Casual Part-Time Total Rewards:Benefits/Incentive Information At every neighborhood Pearle Vision we believe nothing should keep patients from getting the eye care they need. We are experts who know that every appointment begins and ends with trust. It's how we stay true to Dr. Pearle's vision of genuine eye care. Pearle Vision is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions. Join our global community of over 200,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry. Discover more by following us on LinkedIn! GENERAL FUNCTION The Associate Optometrist is responsible for creating exceptional value in the lives of our patients by delivering and leading the execution of NECE. Partners with the Store Manager and...

The Senior Manager, Global Product Quality - Biologics is responsible for managing quality oversight of clinical and commercial products at CMOs under contract by Otsuka to ensure that they are manufactured, packed, labelled, stored, and transported in a controlled way that is in accordance with regulatory expectations and applicable GMP/GDP quality standards. This role will provide specialized Biologics Quality Assurance support, including oversight of upstream and downstream biologics manufacturing processes, ensuring compliance with biologics-specific GMP requirements. This role has global responsibility for managing clinical and commercial product quality to ensure global supply for Otsuka's patients. Job Description Provides Biologics QA support for Drug Substance and Drug Product, including upstream and downstream biologics manufacturing processes, ensuring GMP compliance for cell culture, bioprocessing, purification, and formulation activities. Responsible...

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...

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...

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...

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 Account Manager - Remote Job Description The Account Manager provides information, analyses, and consulting to Health Plan and Prime senior management. The Account Manager supports senior management and Health Plan Markets teams in communications, client-facing initiatives, including a focus on managing projects and issue management. This role must establish and maintain relationships with designated client counterparts in the pharmacy department and other key client functions as determined by the Sr. Director/Director. Responsibilities Perform business analysis work for client-facing needs. Knowledge of PBM functions such as but not limited to customer service, claims, benefits, prior authorizations,...

Primary Functions: This is a full-time Springfield-based position. The Business Manager is a key administrative and operational leader responsible for managing the financial, administrative, and business functions of the Illinois Association of Chiefs of Police (ILACP) and its Foundation. This position ensures efficient day-to-day operations, supports grant administration, oversees financial processes, and provides support and reports to the Executive Director, the Deputy Director, the President, and the Financial Committee. The Business Manager plays a central role in ensuring the organization remains compliant, organized, and functions smoothly. This is a family-friendly position with a 40-hour work week. Start Date: As soon as possible Salary: $65,000 - $70,000 based on experience and qualifications. Benefits: · Health and Dental Insurance · Life Insurance · Simple IRA 3% Match · Flexible Work Schedule · Workers Compensation · Vacation, sick, and personal...

Job Description Manage a team that designs, develops, troubleshoots and debugs software programs for databases, applications, tools, networks etc. As a manager of the software engineering division, you will apply your knowledge of software architecture to manage software development tasks associated with developing, debugging or designing software applications, operating systems and databases according to provided design specifications. Build enhancements within an existing software architecture and occasionally suggest improvements to the architecture. Leads a specialized area which may have diverse functional elements. Frequently interacts with supervisors and/or functional peer group managers. May interact with senior management. Demonstrated leadership and people management skills. Strong communication skills, analytical skills, thorough understanding of product development. BS degree or equivalent experience relevant to functional area. Minimum ten years of software...