30 general claims manager jobs found in Harrisburg

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...

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...

Company Description At Western Digital, our vision is to power global innovation and push the boundaries of technology to make what you thought was once impossible, possible. At our core, Western Digital is a company of problem solvers. People achieve extraordinary things given the right technology. For decades, we've been doing just that. Our technology helped people put a man on the moon. We are a key partner to some of the largest and highest growth organizations in the world. From energizing the most competitive gaming platforms, to enabling systems to make cities safer and cars smarter and more connected, to powering the data centers behind many of the world's biggest companies and public cloud, Western Digital is fueling a brighter, smarter future. Binge-watch any shows, use social media or shop online lately? You'll find Western Digital supporting the storage infrastructure behind many of these platforms. And, that flash memory card that captures and preserves...

Become a part of our caring community and help us put health first The Grievances & Appeals Representative 2 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Grievances & Appeals Representative 2 assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work...

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....

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: Our Performance Suite Analytics team offers candidates the opportunity to support the evolution of value-based care across all lines of business by collaborating directly with our...

Job Description Fusion Data Intelligence Content Development aims to enable customers to fully leverage their data by offering top-tier out-of-the-box content as well as a very flexible customization framework. Within this organization, our team includes experts of Oracle Analytics and Fusion Data Intelligence committed to troubleshooting customer incidents. We analyze and mitigate production incidents raised to the development team, take a step back to see the overall picture, propose enhancements to the product and incident management process to Reduce the number of incidents Reduce the time to resolution Improve customers capabilities to avoid the issue or find solutions themselves Improve application performance The candidate will collaborate with multiple Oracle development teams as well as Oracle Support. We have a minimum bar for this role to either have or gain security clearance for US Government work. Clearance is a requirement for...

General information Date Friday, January 16, 2026 City Harrisburg State PA Country United States Working time Full-time Description & Requirements Maximus is currently hiring for a Document Processing Supervisor to support the Pennsylvania Independent Enrollment Broker (PA IEB) program. This is a hybrid remote opportunity requiring you report to Harrisburg, PA 2-3 times per week. The Document Processing Supervisor’s responsibility is to provide training, answer technical and procedural questions, manage task assignments, ensure disciplinary actions are taken when appropriate, support operational and corporate initiatives, and maintain accurate and current work instructions. The ideal individual should be detail oriented, customer focused, organized, and proactive answering questions and resolving issues. The Supervisor will be leading and developing a team to meet individual and team performance objectives. Why Maximus? 💰 Competitive...

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...

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...

Company : Highmark Inc. Job Description : GENERAL OVERVIEW: The Quality analyst is responsible for compiling and analyzing data relevant to the handling of all types of complex adjusted claims; conducting reviews of all organizational or functional activities related to fraud/abuse perpetrated by providers, subscribers, facilities, pharmacies, provider employees and/or employees of the company and ensuring Highmark compliance with all adjustment processes based on SOX remediation and Regulatory and legal guidelines. In addition, the Analyst will identify potential areas of processing vulnerability through procedure review and report trending/analysis; generate reports for analysis and/or sampling; review audit samples for accuracy and appropriateness; train operational staff on processes, act as the subject matter expert for all audit adjustment processes for workgroups, recommend and implement process changes, and coaching quality review staff. As a result of the...

Customer Service Rep. Req number: R6896 Employment type: Full time Worksite flexibility: Remote Who we are CAI is a global technology services firm with over 8,500 associates worldwide and a yearly revenue of $1 billion+. We have over 40 years of excellence in uniting talent and technology to power the possible for our clients, colleagues, and communities. As a privately held company, we have the freedom and focus to do what is right-whatever it takes. Our tailor-made solutions create lasting results across the public and commercial sectors, and we are trailblazers in bringing neurodiversity to the enterprise. Job Summary As the Customer Service Representative you will be the first point of contact for our providers, delivering exceptional support and addressing inquiries related to behavioral and physical health services. Job Description We are seeking Customer Service Representatives to join our team. In this role, you will be the first...

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...

The Director, CNS Publications Lead is responsible for leading the planning, development, and execution of the global medical publication strategy and publication deliverables for the CNS therapeutic area. This role ensures the timely, accurate, and compliant communication of scientific and clinical data through congress abstracts, posters, manuscripts, and other peer-reviewed outputs. Serving as the functional lead for publication operations within the CNS Medical Communications team, the Director partners closely with cross-functional stakeholders, including Clinical Development, Global Integrated Evidence & Innovation (GIE&I), Medical Strategy, Core Content, and external vendors, ensuring excellence and consistency in scientific communication across the portfolio. The position reports to the Senior Director, CNS Medical Communications Lead and plays a key leadership role in advancing Otsuka's mission to deliver impactful, evidence-based science that improves...

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...

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...

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...

Become a part of our caring community and help us put health first The Network Operations Coordinator 4 maintains provider relations to support customer service activities through data integrity management needed for service operations. The Network Operations Coordinator 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Network Operations Coordinator 4 manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others...