33 general claims manager jobs found

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...

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...

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 Humana. 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. 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...

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...

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 Otsuka America Pharmaceutical Inc.. 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. Director, Training Management Operations Lead The Director, Training Management Operations Lead, is a senior leader within the Learning Center of Excellence (CoE) under Global Quality. This role is responsible for overseeing the end-to-end management of global training operations, ensuring compliance with regulatory requirements, operational efficiency, and alignment with corporate quality objectives. The position drives governance, technology enablement,...

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...

* *ALL APPLICANTS MUST APPLY DIRECTLY THROUGH THE CPCS iCIMS WEBSITE. IF YOU APPLY THROUGH MASS CAREERS AND DO NOT COMPLETE THE CPCS iCIMS APPLICATION, YOU WILL NOT BE CONSIDERED FOR THIS POSITION. PLEASE USE THE FOLLOWING LINK TO APPLY (CUT AND PASTE INTO YOUR BROWSER IF THE EMBEDDED LINK DOES NOT WORK): https://careers-publiccounsel.icims.com/jobs/2998/benefits-manager---human-resources/job The Committee for Public Counsel Services (CPCS), the public defender agency of Massachusetts, is seeking a Benefits Manager to oversee all aspects of Leaves of Absence and reasonable accommodations, serves as the Agency GIC Coordinator, and manages SMART Plan administration. This position is eligible for a hybrid work schedule with a minimum of two days per week in our Boston Office. In this role, you would join a strong, experienced HR team supporting an organization of passionate professionals providing legal services to indigent clients in...

Overview: The Committee for Public Counsel Services (CPCS), the public defender agency of Massachusetts, is seeking a Benefits Manager to oversee all aspects of Leaves of Absence and reasonable accommodations, serves as the Agency GIC Coordinator, and manages SMART Plan administration. This position is eligible for a hybrid work schedule with a minimum of two days per week in our Boston Office. In this role, you would join a strong, experienced HR team supporting an organization of passionate professionals providing legal services to indigent clients in Massachusetts. We fight for equal justice and human dignity by supporting our clients in achieving their legal and life goals. We zealously advocate for the rights of individuals and promote just public policy to protect the rights of all. Our Values C ourage • A ccountability • R espect • E xcellence DIVERSITY AND INCLUSION MISSION STATEMENT CPCS is committed to protecting the...

Overview The Committee for Public Counsel Services (CPCS), the public defender agency of Massachusetts, is seeking a Benefits Manager to oversee all aspects of Leaves of Absence and reasonable accommodations, serves as the Agency GIC Coordinator, and manages SMART Plan administration. This position is eligible for a hybrid work schedule with a minimum of two days per week in our Boston Office. In this role, you would join a strong, experienced HR team supporting an organization of passionate professionals providing legal services to indigent clients in Massachusetts. We fight for equal justice and human dignity by supporting our clients in achieving their legal and life goals. We zealously advocate for the rights of individuals and promote just public policy to protect the rights of all. Our Values C ourage A ccountability R espect E xcellence DIVERSITY AND INCLUSION MISSION STATEMENT CPCS is committed to protecting the fundamental constitutional...

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,...

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...

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...

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, 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 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...

Job Title Sr. Facilities Manager Job Description Summary This position has managerial oversight of multiple facilities, an entire campus, or a portfolio of client facilities and has at least one Facilities Manager and/or Assistant Facilities Manager reporting into it. The Senior Facilities Manager has the overall responsibility for overseeing the implementation of policies, procedures and programs that will assure well-managed, well-maintained buildings and facilities, placing maximum emphasis on leading a staff in the positive response to the concerns and needs of the tenants, environmental health and safety, and quality programs, in coordination and conjunction with the goals and objectives of the client. The position is the primary liaison with the client and leads staff in the coordination of services and activities, financials, vendors and manpower required for current and future needs of the building and operations. The Senior Facilities Manager also has...

Position: Director Research Analytics & Reporting, Research Executive Services Location: Boston, MA Schedule: 40 hours per week, Remote ABOUT BMC: At Boston Medical Center (BMC), our diverse staff works together for one goal — to provide exceptional and equitable care to improve the health of the people of Boston. Our bold vision to transform health care is powered by our respect for our patients and our commitment to ensure everyone who comes through our doors has a positive experience. You’ll find a supportive work environment at BMC, with rich opportunities throughout your career for training, development, and growth and where you’ll have the tools you need to take charge of your own environment. POSITION SUMMARY : The Director of Research Data Analytics & Reporting leads the design and execution of data strategies that support the goals of Research & Sponsored Programs (RSP) and position Boston Medical Center Health System...

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...

Compensation Pay Range: $15.00 - $20.00 The actual hourly rate will equal or exceed the required minimum wage applicable to the job location. Additional compensation includes annual, quarterly performance, or premiums may be paid in amounts ranging per hour in specific circumstances. Premiums may be based on schedule, facility, season, or specific work performed. Multiple premiums may apply if applicable criteria are met. The Assistant Store Manager will support the Store Manager in areas of sales, customer service, store appearance and store operations. This position will manage the store during the Store Manager’s absence and/or when working opposing shifts. The Assistant Manager will be expected to lead the store team members in servicing customers. Bilingual candidates encouraged to apply. ESSENTIAL JOB FUNCTIONS Lead the store team members in providing excellent customer service to retail and professional customers. Supervise the customer service levels on...

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...

At Sonos we want to create the ultimate listening experience for our customers and know that it starts by listening to each other. As part of the Sonos team, you’ll collaborate with people of all styles, skill sets, and backgrounds to realize our vision while fostering a community where everyone feels included and empowered to do the best work of their lives. This role is a hybrid position Some roles require an office while others may be done remotely. This position is considered hybrid, allowing for a combination of remote work and in-office collaboration. Qualified applicants must live within commuting distance of our Boston, Santa Barbara or Seattle office locations. As Senior Accountant, Global Business Services - Revenue, this role will oversee the outsourced revenue process. This includes leading centralization and transition efforts of regional processes to the GBS team. It also includes analyzing & reporting of revenue and collaborating closely...