14 claims representative jobs found in Lansing

Job Summary In collaboration with the Senior Director of Clinical Management, the Director is responsible for the operational strategy and management of Otsuka clinical programs, including coordination with other relevant parties (e.g., other Otsuka departments, external service providers (ESPs), etc.). Responsibilities include the planning, execution, and completion of clinical programs according to applicable regulations and guidance; ICH Guidelines, Good Clinical Practices (GCP), and Otsuka SOPs, within agreed upon timelines and budget. Job Description Provides scientific clinical research and operational expertise in the development of overall strategy and objectives of the Global Clinical Development Plan (GCDP), including performing/overseeing and providing background research. May represent Clinical Management in the development of the Clinical Development Plan, timelines, and budget for Business Development opportunities. Ensures program specific...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. ESSENTIAL RESPONSIBILITIES Communicate effectively with physician and pharmacy network providers to ensure that the needs of the...

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 Prime Therapeutics. 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 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 Provider Educator - Remote in California Job Description Ensures providers and prescribers are aware of Plan policy and requirements for claims submissions and/ or prior authorization (PA) requests. Conducts outbound calls...

At Bayer we're visionaries, driven to solve the world's toughest challenges and striving for a world where 'Health for all Hunger for none' is no longer a dream, but a real possibility. We're doing it with energy, curiosity and sheer dedication, always learning from unique perspectives of those around us, expanding our thinking, growing our capabilities and redefining 'impossible'. There are so many reasons to join us. If you're hungry to build a varied and meaningful career in a community of brilliant and diverse minds to make a real difference, there's only one choice. Field Sales Rep III: Northern Michigan The Crop Protection (CP)/Seeds & Traits (S&T) Field Sales Representative is responsible for growing the market share of crop protection/seed business within a designated geography. This position will create demand for Bayer seed growth, crop protection, and seed products with retailers, dealers, and top growers, with responsibility for an annual target...

Otsuka America Pharmaceutical, Inc. A customer engagement approach is designed to better deliver on patient, caregiver and HCP needs in an evolving healthcare environment. This model is built around where patients get their care-locally, with the intent to better serve patients, caregivers, and healthcare providers, delivering a higher quality experience that ultimately is focused on improving patient care. The local "ecosystem approach" creates a unified focus among account management, medical, patient access, marketing and market access to engage local healthcare systems and identify opportunities to improve the patient experience. Through this matrix model, customers will now experience more coordinated and seamless care with digital-enabled support to help bridge care gaps. Position Overview - Senior Medical Science Liaison As an integral member of the ecosystem team for Otsuka's ecosystem-based customer engagement model, the Senior Medical Science Liaison (MSL),...

Job Summary: The Senior Manager, Clinical Technical Operations within Clinical Operations is responsible for supporting the implementation, integration, and optimization of technical systems and processes that support the planning, execution, and oversight of clinical trials. This role bridges the gap between clinical operations and technical functions, ensuring that digital tools, platforms, and data systems are effectively leveraged to drive operational efficiency, compliance, and data integrity. The Senior Manager will collaborate cross-functionally with Clinical, Data Management, IT, Quality, and external vendors to support system implementation, process automation, and continuous improvement initiatives. This role also includes oversight of technical service providers and may involve line management responsibilities. Key Responsibilities: Technical Systems Oversight - Support the implementation, configuration, and maintenance of clinical operations systems...

Position Summary The Associate Director of MSAT (Manufacturing Science & Technology) - Analytical Sciences will serve as a scientific and technical leader supporting tech transfer, and commercial manufacturing of biologic drug substances and drug products. This role oversees analytical lifecycle management, method qualification/validation, comparability, control strategy implementation, and investigations. The ideal candidate brings deep expertise in biologics analytics, strong cross-functional leadership, and experience working with external contract manufacturing companies. Key Responsibilities Lead the analytical sciences function within MSAT to ensure robust support for commercial manufacturing of biologics (e.g., mAbs, fusion proteins). Drive analytical control strategy, specification setting, and lifecycle management in alignment with QbD principles. Oversee method performance monitoring and trending, analytical capability assessments, and...

Job Summary: The Director of Patient Experience Data and Clinical Outcome Assessments (PED&COA) leads the strategic integration of patient-centered outcomes into assigned global assets and programs. This role encompasses early development, regulatory submissions, post-marketing studies, and life-cycle management, ensuring patient perspectives are embedded throughout the drug development process. As a key member of the Global Integrated Evidence & Innovation team, the Director (PED&COA) will develop and execute a scientifically rigorous, patient-focused global strategy for Patient-Centered Outcomes Research (PCOR). This role ensures alignment with FDA guidance on patient-focused drug development (PFDD), regulatory expectations, and health technology assessment (HTA) requirements, while advancing Otsuka's commitment to create innovative, high-quality products for better health worldwide. Job Description: Patient-Centered Outcomes Research (PCOR):...

Job Description: The Senior Manager of Field Training and Development, collaborates and communicates closely with the Team Leader in the Field Training and Development Department to develop and drive the achievement of department objectives and responsibilities. Leads in coordinating closely with peers to ensure that learning needs are identified, training programs are developed, and actively implements learning experiences that strengthen the capabilities of customer-facing field personnel to drive business growth. Works cross-functionally with Brand teams, Field Leadership, Medical, and other internal key stakeholders along with external vendors to ensure Field Training and Development programs/deliverables are in alignment with brand/company strategies to support the achievement of commercial business objectives. Key Functions: Collaborates and communicates with peers in Field Training and Development Department to achieve department...

The Director, Medical Excellence & Operations (ME&O) Insights & Analytics will lead the development and execution of a global strategy for integrating and leveraging data-driven insights across multiple Global Medical Affairs (GMA) functions. This role will be responsible for managing the Manager, Medical Analytics and is pivotal in shaping how GMA uses analytics to optimize performance, enhance decision-making, and deliver measurable impact across therapeutic areas. The Director, Medical Excellence & Operations (ME&O) Insights & Analytics will report to the Senior Director, Medical Affairs Solutions & Analytics and will leverage strategic vision, operational excellence, and expertise in data integration to drive innovation and efficiency across functions such as Medical Information, Field Medical, Medical Strategy, and Medical Education. Preferred therapeutic experience includes Nephrology, Central Nervous System (CNS), and rare disease. Key...

Otsuka's internship program, Intern the Otsuka Way (InTOW), offers students a unique opportunity to gain hands-on experience and develop critical skills while contributing to meaningful projects. Interns will work alongside experienced professionals, learn about the complexities of the pharmaceutical industry, and gain insights into potential career paths. By combining practical experience with professional development, our program prepares interns for future success. Our internship program also includes instructor-led trainings, a leadership engagement series, as well as insightful lunch and learns. Application Deadline: Candidates are encouraged to apply within 10 business days of the posting date. The position may remain open past this window until a suitable candidate is selected. Interviews and offers: February through March 2026. Duration of internship: June 1, 2026, through August 10, 2026. Job Description ? The Data Governance & Data Integrity...

Otsuka's internship program, Intern the Otsuka Way (InTOW), offers students a unique opportunity to gain hands-on experience and develop critical skills while contributing to meaningful projects. Interns will work alongside experienced professionals, learn about the complexities of the pharmaceutical industry, and gain insights into potential career paths. By combining practical experience with professional development, our program prepares interns for future success. Our internship program also includes instructor led trainings, a leadership engagement series, as well as insightful lunch and learns. Application Deadline: Candidates are encouraged to apply within 10 business days of the posting date. The position may remain open past this window until a suitable candidate is selected. Interviews and offers: February through March 2026. Duration of internship: June 1, 2026, through August 10, 2026. Job Description The Global Medical Affairs Rare Diseases Intern...

Otsuka's internship program, Intern the Otsuka Way (InTOW), offers students a unique opportunity to gain hands-on experience and develop critical skills while contributing to meaningful projects. Interns will work alongside experienced professionals, learn about the complexities of the pharmaceutical industry, and gain insights into potential career paths. By combining practical experience with professional development, our program prepares interns for future success. Our internship program also includes instructor led trainings, a leadership engagement series, as well as insightful lunch and learns. Application Deadline: Candidates are encouraged to apply within 10 business days of the posting date. The position may remain open past this window until a suitable candidate is selected. Interviews and offers: February through March 2026. Duration of internship: June 1, 2026, through August 10, 2026. Location: In Princeton 2-3 days a week Job Description ?...

Job Summary ?: Otsuka's internship program, Intern the Otsuka Way (InTOW), offers students a unique opportunity to gain hands-on experience and develop critical skills while contributing to meaningful projects. Interns will work alongside experienced professionals, learn about the complexities of the pharmaceutical industry, and gain insights into potential career paths. By combining practical experience with professional development, our program prepares interns for future success. Our internship program also includes instructor led trainings, a leadership engagement series, as well as insightful lunch and learns. Application Deadline: Candidates are encouraged to apply within 10 business days of the posting date. The position may remain open past this window until a suitable candidate is selected. Interviews and offers: February through March 2026. Duration of internship: June 1, 2026, through August 10, 2026. Job Description ? The Junior Scientist...