63 general claims manager jobs found

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...

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 Cushman & Wakefield. 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 Title Regional 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. Job Description POSITION SUMMARY This position has managerial oversight of multiple facilities, an entire campus, or a portfolio of client facilities and has at least one Facilities...

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 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...

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...

Bring YOUR energy to Alliant Energy! At Alliant Energy, our purpose is to serve customers and build stronger communities. We are passionate about powering beyond the market challenges of today, while powering what's next in energy. When our employees say "I am energy", it means they take pride in the work we do when disaster strikes, as well as all the days in between. We want you to be safe, happy and healthy. That's why we prioritize safety, offer volunteer opportunities and provide competitive pay, comprehensive health and retirement benefits, tuition reimbursement and paid time off. Job Summary Key Account Manager I supports and coordinates activities relating to accounts of commercial and industrial (C&I) customers such as office complexes, hotels, hospitals, production sites, and other commercial properties. This position assists in negotiating, securing, or administering service contracts, tariffs, and agreements that meet customer needs to keep their businesses...

Job Title Regional 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. Job Description POSITION 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...

Summary This position is located within Prosthetic & Sensory Aids Service (PSAS) of the Prosthetic Service Line at the VA Medical Center in Iowa City, Iowa. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Duties ** *THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** This position involves a multi-grade career ladder. The major duties listed below represent the full performance level of GS-6. At the GS-5 grade level, you will perform assignments of a more limited scope and with less independence. You will progressively acquire the background necessary to perform at the full performance level of GS-6. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher level work, and availability of funds. Duties include, but are not limited to, the...

At Otsuka our mission is to create new products for better health worldwide. Our purpose is to defy limitation so that others can too. In this exciting role, as a Sr. Analyst within OAPI supply chain team, you will work cross-functionally across various departments to support implementation of the S&OP (Sales & Operations Planning) process. You will assist in managing a complex portfolio of products with competing priorities that include balancing inventory, managing vendor / supplier relationships, optimizing total delivered cost to meet finished goods demand with focus on delivering value to our patients, our suppliers, and to Otsuka. You will create an environment for proactive communications with cross functional collaborators that will help ensure both internal and external customer demands are consistently met with no laps in supply and availability of products to our patients. Additional facets of the role include coordinating purchase requisitions in the...

Summary The Marriage and Family Therapist (MFT) serves as a member of the Behavioral Health Interdisciplinary Program (BHIP). The BHIP is a multi-disciplinary team of mental health professionals which provides comprehensive, accessible, Veteran-centered mental health care. The MFT assigned to BHIP is responsible for coordinating and providing specialty mental and health therapy with a focus on couples, families, individuals, and groups utilizing systemic health theories. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Internal to an agency Current federal employees of the hiring agency that posted the job announcement. Clarification from the agency This job is open to current permanent Department of Veteran Affairs employees, current permanent Federal employees of other agencies and all US Citizens. Area of Consideration - Eligible applications will be reviewed and referred in the...

Location: West Des Moines, IA Salary: $100,000.00 USD Annually - $120,000.00 USD Annually Description Accounting Business Systems Analyst (BSA) Hybrid – West Des Moines, Iowa Salary - $100-120K About The Role The Accounting BSA serves as the key liaison between Accounting/Finance and IT, ensuring financial systems, insurance processes, and integrations align with business needs and regulatory requirements. This role supports system design, implementation, data integrity, and insurance‑focused accounting operations. Key ResponsibilitiesRequirements Gathering & Analysis Partner with Accounting, Finance, and Insurance Operations to collect and document business requirements. Analyze insurance workflows including policy administration, premium billing, claims accounting, commissions, and reinsurance (ceded/assumed). Translate business needs into system designs, process flows, user stories, and acceptance criteria. System Implementation...

Requisition I D : 915305 Store #: WM0187 Optical Corp Order Entry FIELD Position : Full-Time Total Rewards: Benefits/Incentive Information Since 1915, Walman Optical has served thousands of independent eye care professionals providing solutions for all of their optical needs. Our experienced and knowledgeable team helps businesses grow while providing quality eyewear and unmatched service for an exceptional patient experience. With us, you’ll bring our most advanced technology and innovative products to our partners. As a division of Walman, our collective mission is to enrich the lives of our customers, employees and the communities we serve through better vision. Walman 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...

Summary $5,000 Sign on Bonus, Creditable Service for Annual Leave Accrual, Public Service Loan Forgiveness Program, Accelerated Promotion Program , and Referral Bonus Awards are available. Shifts and species will vary based on assignment. For add'l information call Heather Bopes at (515) 419-2027. Employee may be detailed to any shift at any plant in the Des Moines District. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Career transition (CTAP, ICTAP, RPL) Federal employees whose job, agency or department was eliminated and are eligible for priority over other applicants. Duties YOU WILL/MAY: Ensure that regulated establishments produce a safe product by executing appropriate inspection methods, determining non-compliance with regulatory requirements, documenting noncompliance and initiating enforcement action, where warranted. Verify that meat and poultry...

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...

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....

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...

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...

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....

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...

$15.75 per hou r Summers off! Nine (9) month position All district benefits in accordance with work agreement Nights and weekends off! Be home when your kids are home! Work the same schedule as your kids’ school schedule! Never take work home with you! PRINCIPAL DUTIES Perform general work connected with the operation of food service, which includes food preparation and handling, as assigned. Assist with cooking as necessary. Assume responsibility of washing and drying pots, pans, trays, and silverware by approved methods. Participate in serving good quality food. Available to work flexible hours. Serve as POS for breakfast and lunch, verifying a reimbursable meal was served. Process daily tally counts for claim reimbursement Assist with general clean up duties. Maintain open, positive communication with all people served by the Food & Nutrition Department. Participate in short courses, meetings, and in-service training, as requested. Attend...

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...

Position Summary: University of Iowa Health Care department Patient Financial Services is seeking a Revenue Cycle Representative (RCR) for an entry-level customer service and financial related position in the health care industry. The Patient Access Management (PAM) Division RCRs will provide exceptional customer service to our external customers: patients, insurance contacts, etc; as well as internal customers. The PAM VA Referral Specialist will work in a high volume, fast-paced, web-based application environment and support a culture of Service Excellence by delivering high quality customer service and maintaining composure in difficult situations. The PAM VA Referral Specialist must have a demonstrated ability to prioritize, multi-task, and quickly change focus in a dynamic team environment. The ability to exhibit compassion and empathy when working directly with patients and/or their families is critical. A person in this role will provide consistent and comprehensive...

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...