35 general claims manager jobs found

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...

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 Sedgwick. 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. By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial...

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,...

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...

POSITION OVERVIEW: Provide support to management in reviewing benefits eligibility and compliance with applicable benefit plans ESSENTIAL JOB DUTIES/RESPONSIBILITIES: 1. Ensure compliance with applicable federal, state, and local regulations governing employee benefit plans, including but not limited to ERISA, ACA, COBRA, HIPAA, MHPAEA, Transparency in Coverage, and the No Surprises Act 2. Review and make recommendations relative to plan administration, system maintenance, and vendor management 3. Update HR leadership in regard to regulatory changes, updates and processes 4. Represent Freight on cross Enterprise project teams as the subject matter expert pertaining to internal benefit programs; keep management and department up-to date on applicable projects 5. Support manager to ensure that effective measurements are implemented and maintained with regard to various third party services 6. Administer benefits eligibility and ensure accurate setup,...

Overview SP+, a Metropolis company, is an artificial intelligence company for the real world. We use computer vision to enable checkout-free parking experiences. So there’s no fumbling with tickets, machines, apps, or credit cards. You just “drive in and drive out.” We are the largest parking network in America, with over 23,000 employees powering mobility at over 4,000 locations across North America and Europe. Today, we are reinventing parking. Because it’s important, it's everywhere and impacts everyone. Tomorrow, we will power checkout-free experiences anywhere you go to make the everyday experiences of living, working, and playing remarkable - giving us back our most valuable asset, time. Responsibilities Position: Assistant Operations Manager - Parking Department Salary Range: $50,000.00 - $57,000.00 per year Flexible Hours Are Required- Includes Some Nights And Weekends Basic Function – Assisting in the day-to-day management of the assigned location...

Overview SP+, a Metropolis company, is an artificial intelligence company for the real world. We use computer vision to enable checkout-free parking experiences. So there’s no fumbling with tickets, machines, apps, or credit cards. You just “drive in and drive out.” We are the largest parking network in America, with over 23,000 employees powering mobility at over 4,000 locations across North America and Europe. Today, we are reinventing parking. Because it’s important, it's everywhere and impacts everyone. Tomorrow, we will power checkout-free experiences anywhere you go to make the everyday experiences of living, working, and playing remarkable - giving us back our most valuable asset, time. Responsibilities Position: Assistant Operations Manager - Parking Department Salary Range: $50,000.00 - $57,000.00 per year Flexible Hours Are Required- Includes Some Nights And Weekends Basic Function – Assisting in the day-to-day management of the assigned location...

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 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. 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...

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, 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 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 - 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 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 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, 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,...

Premise Health is Different on Purpose Premise Health serves large organizations and their people with exceptional healthcare. The result? Better experiences, better health, and better value, all while helping organizations lower their healthcare costs. Premise's mission is to help people get, stay, and be well. Come join us and see for yourself why amazing health starts with amazing healthcare. For more information, visit www.jobs.premisehealth.com. The RCM Account Manager (AM) serves as the strategic partner and primary point of contact for assigned clients, with a core focus on account management, consultative support, and client success. The AM is responsible for proactively managing client relationships, understanding clinic operations, and advising revenue cycle strategies that drive performance improvement and operational efficiency. The AM must possess a deep knowledge of revenue cycle management (RCM) and the key performance indicators (KPIs) that influence client...

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 the retail showroom to include team member execution on customer service programs (Related sales, Hi5, Rock the Call, Never Say No, Rock the Lot, etc…) Work with the store manager to ensure the retail sales counter is adequately staffed, especially during peak retail business hours (lunch, late- afternoons, evenings, weekends, etc.) Assist the store manager in setting team member goals, providing feedback on goal...

Requisition Id 15573 Overview We are seeking a visionary and collaborative leader and scholar to serve as the Executive Director and Vice Provost of the University of Tennessee-Oak Ridge Innovation Institute (UT-ORII). Located at the Oak Ridge National Laboratory (ORNL) in the beautiful foothills of the Great Smoky Mountains and near the lively and historic city of Knoxville, the UT-ORII is an exciting and unique organization that focuses on innovation and education. Building on an 80+ year partnership between ORNL and the University of Tennessee (UT), UT-ORII melds select strengths of both organization to accelerate impacts at scale. ORNL is the largest Office of Science national laboratory in the U.S. Department of Energy system, with over 7,400 staff, world-leading user facilities, and an extraordinary breadth of expertise across neutron science, computational science, materials science, nuclear energy, isotopes, biological and environmental sciences, national...

Nashville (Charlotte), TN 5708 Charlotte Pike, Nashville, TN 37209-3215, United States of America Pay : $15.00 - $15.50 It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. As an integral member of our team, the Assistant Manager will be responsible for assisting in the oversight of club operations to ensure an exceptional “Judgement Free” member experience. This position will work closely with the Club Manager to build a positive and enthusiastic team atmosphere as well as a financially successful club. Essential Duties and Responsibilities Assist in recruiting, hiring, training and developing a high performing staff consisting of Member Service Representatives, Trainers and Custodians. Assist in maintaining a welcoming atmosphere for all members, prospective members and guests, and ensuring staff follows superior customer service guidelines. Assist with...

Summary Corrections professionals who foster a humane and secure environment and ensure public safety by preparing individuals for successful reentry into our communities. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency • THIS IS A DELEGATED EXAMINING ANNOUNCEMENT OPEN TO ALL U.S. CITIZENS. • Duty Location: FCI Memphis, TN Duties Receives visitors, determines the nature of the requests, personally providing the information desired when it is of a routine or procedural matter, before referring them to the Associate Warden. Maintains supervisor’s calendar, takes request for appointments with supervisor and staff. Serves as a liaison to the Associate Warden, personally processing requests. Responsible for the preparation in draft and/or final form of material such as memoranda, letters, reports, requests, etc., as assigned. Along with all other...

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...