28 ltc claims operations manager jobs found

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...

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 Sr Health Informatics Analyst - Remote Job Description The Sr. Health Informatics Analyst leads advanced data initiatives that support clinical programs, cost containment strategies, and operational effectiveness. This role partners with cross-functional teams, including clinical services, pharmacy operations, product management, and client services, to transform complex healthcare data into actionable insights. The position applies advanced statistical, analytic, and business acumen, and champions evidence-based decision-making, regulatory compliance, and improved patient and business outcomes. Responsibilities Analyze large-scale healthcare claims, eligibility, provider, and clinical data to identify trends,...

Primary Job Function: The Claims Adjuster is responsible for the set-up and processing of automotive VSC claims filed with our company that cover mechanical breakdown, appearance, tire & wheel and other benefits. This includes reviewing repair estimates, inspection reports, supporting documentation, communicating with repair facilities, and ultimately determining coverage. Company Description: Delivers industry-leading administration services for automotive F&I-related, voluntary protection products such as VSC, Appearance, Tire & Wheel, Key Replacement, GAP and Theft-deterrent protection. We process and adjust claims for these contracts within programs that are underwritten by only Excellent (A- or better) rated Insurance Carriers. As a rapidly growing automotive F&I product provider with over 30 years of continuous operation in the Automotive F&I space, our operating partners include seasoned Insurance Agents, national Lenders and their client Automotive...

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 The LTC Account Manager delivers results by strategically educating key LTC stakeholders including closed door pharmacies, consultant pharmacists, and Tier 1 Nursing Home chains in a compliant and ethical manner, while collaborating with the sales team on educating LTC Healthcare Providers on SMPA product clinical attributes for the LTC resident. They ensure customer satisfaction by understanding...

At Zelis, we Get Stuff Done. So, let’s get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are....

At Zelis, we Get Stuff Done. So, let’s get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are....

The DI Underwriting Medical Consultant , reporting to the Manager, Underwriting Policy and Support in the Underwriting Policy area, is a key business partner for DI Underwriting. This position assists in maintaining the DI underwriting guidelines and is responsible for reviewing individual health risk characteristics for complicated applicants, assisting in making recommendations to underwriting. The role combines clinical judgment, analytics, and strong communication. The applicant should be a medical professional who can understand health conditions and personal characteristics, singly and in combination, and how they influence the probability of disability. You will Assist with medical reviews of current underwriting cases Review older underwriting and claims files when needed to support ongoing IDI underwriting policy research projects Medical guideline authorship, drafting, updating and driving change across underwriting Review medical literature...

Position Summary Serves as the key stakeholder and subject matter expert (SME) representing Medical review function in internal audits, and health authority inspections. Being available on-site for inspections, internal audit and critical business activities, including at short notice. Provides oversight of the safety profile of Otsuka products Leads the development and execution of medical review strategies for investigational and marketed products Provides strategic leadership of the Global Medical review function and collaborates with other PV functions, vendors and partners. Serves as a member of the Global Medical Safety (GMS) Leadership Team partnering closely with the GMS Head Meets routinely with product specific GPV team members and acts as principal liaison for medical review matters to engage with regulatory agencies on product safety issues. Key Job Responsibilities Represents GPV Medical Safety department from a...

Senior Planning and Scheduling Manager, Mission Critical Location: Kansas City, MO, US, 64106 Best People + Right Culture. These are the driving forces behind JE Dunn's success. By hiring inspired people, giving them interesting and challenging work, enabling them with innovative tools, and letting them share in the company's rewards, we've found a sustainable way to grow in our industry for the last 100+ years. Our diverse teams around the country strive to enrich lives through inspired people and places everyday, and we need inspired people like you to join us in our pursuit of building perfection. JE Dunn's Advanced Facilities Group (AFG) combines Mission Critical, Advanced Industries, and Industrial & Manufacturing into one high-performing team focused on cutting-edge work to serve innovative clients on large Industrial & Manufacturing, Data Center, and Semiconductor projects. As part of the Advanced Facilities team, you'll work on some of the most...

Responsible for performing the clerical and administrative functions for any or all hub and station operational areas, including linehaul, quality assurance and customer service. Tends to damaged and incorrectly addressed packages in a timely manner to optimize delivery time. Serves as a customer’s first line of contact for a variety of issues. Essential Functions Provides clerical support to various management and operational functions, including, but not limited to, photocopying, filing, faxing, emailing and answering telephone Reviews, researches and/or enters data in various systems to support respective functional area Compiles data and provides various regular and adhoc reports to management for review and determination Serves as frontline customer service to receive, solve and/or escalate customer inquiries and issues Assists management with Business Control Self Assessment (BCSA) audit activity by retrieving data and/or files for review In addition to...

Kansas City - Missouri - United States of America At CBRE Global Workplace Solutions (GWS) , Safety is our top priority! We maintain a safety-first culture in which CBRE employees return home in the same condition in which they reported to work. We’re looking for a skilled and forward-thinking FM Engineering Ops Sr Manager / Automation Engineering Manager (AEM) to join our growing team as we work to service one of the world’s largest online retailers. We offer competitive pay, a robust benefits package, wellness programs, and a workplace environment that embraces diversity. Come join our global network of professionals supporting client operations across CBRE. Looking for a rewarding career in Engineering? Read on to learn more! About The Role In this vital leadership role as Automation Engineering Manager (AEM) , the ideal candidate will manage a team responsible for supporting the operations of the customer’s technical problems related to their automated material...

Company Description Why Wellmark : We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! Learn more about our unique benefit offerings here. Want to know more? You can learn about life at Wellmark here. Job Description Wellmark is looking for a highly experienced health care professional with at least 10+ years of experience in the industry, including 5+ years working directly with employer benefit consultants. The ideal candidate will bring a strong blend of robust sales acumen, industry-specific knowledge, and technical prowess, allowing them...

Summary This position is in the Research & Development (R&D) Service at the VA St Louis Health Care System (VASTLHCS) in St. Louis, Missouri. The incumbent will provide a high level of assistance to the Principal Investigator (PI) in coordinating the recruitment, clinical interviewing, data collection and data analysis as well as administrative aspects of assigned studies. 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*** Duties include but are not limited to the following: Provides administrative and program support to research and clinical projects. Assists investigators and project staff with day-to-day research operations. Supports participant recruitment, screening, and scheduling activities. Collects, enters, maintains, and...

Summary This announcement is only open to the public. All currently employed by the Department of Veterans Affairs only must apply to CBSS-12877833-26-TW to be considered. The Supervisory Diagnostic Radiologic Technologist (DRT) of complex modalities in the Radiology service line at the Kansas City VA Medical Center, supervises Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) technical staff in those modalities. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below. This announcement is only open to the public. All currently employed by the Department of Veterans Affairs only must apply to CBSS-12877833-26-TW to be considered. with current SF-50 and Resume to be considered. Duties This vacancy is for the Diagnostic Radiologic...

Planning and Scheduling Manager Location: Kansas City, MO, US, 64106 Best People + Right Culture. These are the driving forces behind JE Dunn's success. By hiring inspired people, giving them interesting and challenging work, enabling them with innovative tools, and letting them share in the company's rewards, we've found a sustainable way to grow in our industry for the last 100+ years. Our diverse teams around the country strive to enrich lives through inspired people and places everyday, and we need inspired people like you to join us in our pursuit of building perfection. Role Summary The Planning & Scheduling Manager will complete most complex activities to prepare project schedules for projects of all sizes and provide team leadership. This position will be responsible for guiding scheduling construction sequencing, developing and delivering training, and supervising critical path analysis. All activities will be performed in support of the...

Sr Regional Dist Center Mgr YOUR TASKS AND RESPONSIBILITIES You will ensure effective execution of the warehousing operations including shipping, receiving, inventory and storage of finished goods to ensure safety and compliance, cost management, and operational excellence. Additionally, you are responsible in collaboration with transportation for 'final mile' of the customer experience. The primary responsibilities of this role, Senior Regional Distribution Center Manager, are to: Organize, lead, and coordinate efforts and resources cross-functionally to identify solutions and make necessary adjustments to processes and procedures; Analyze data to identify trends, troubleshoot, and support Continuous Improvement; Provide written and oral communications to key stakeholders and senior Product Supply leaders; Drive operational excellence at assigned third-party distribution centers; Execute necessary actions to resolve issues, claims, or...

Position Summary We are seeking a dynamic and experienced Associate Director to lead operations for the relevant therapeutic area Patient Access team, focusing on enhancing patient experience and optimizing support programs. This role will support strategic initiatives, manage across cross-functional teams, and ensure the delivery of innovative patient-centric solutions. This role reports to the Senior Director, Patient Access and serves as the primary day-to-day operational lead for Patient Access programs. The position will work in close partnership with the Director, Market Access Operations, and the Director, Field Reimbursement to ensure seamless execution of access strategies. The individual will act as a key operational advisor and collaborator to drive program excellence. Key Responsibilities The position provides operational and tactical support for the relevant therapeutic area Patient Access team and leads projects collaborating with various cross-functional...

Pay,Benefits, & Work Schedule Full-time position available with the Water Department, Meter Field Services Division, located at 1720 Wabash Ave. Salary Starting at: $7,268/month Normal Work Days/Hours: Monday-Friday 8:00a.m.-4:30p.m. Application Deadline Date: February 20, 2026 Responsibilities Recruits, trains, and directs four Utility Supervisors and labor staff. Prioritizes and schedules work; assigns specific projects and responsibilities to subordinates. Evaluates performance by conducting quarterly reviews and completing annual performance appraisals. Maintains administrative accuracy regarding timekeeping records, safety training, and equipment logs. Oversees the installation, maintenance, and quality control of water meters and Meter Transmitter Units (MTU) to ensure accurate data transmission and billing. Directs leak location services for mains and service lines using advanced leak detection equipment. Trains and...

Why Work for Saddle Creek? Saddle Creek Logistics Services succeeds by promoting a diverse, friendly, and respectful teamwork environment. As a vital service provider, we not only make a difference in our community but offer our associates opportunities to enhance their skills, build meaningful careers and end each day with a sense of accomplishment. If you’re looking for a family-oriented company that lives by its values and offers competitive pay and benefits, join our team today. Note that if you are viewing this posting on an external job board (such as Indeed, LinkedIn, ZipRecruiter, etc.), unless specifically stated in the posting, the provided salary estimates may not be accurate as they are not provided by Saddle Creek. Our recruiters look forward to speaking with you about your background, skills, and compensation requirements. Location: Belton, MO Shift: 1st shift, Monday - Thursday. Friday work may be required based on business needs....

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 Supervisor - Remote Job Description The Supervisor is responsible for overseeing daily production goals and supporting key product offerings, including Benefit/Network/Formulary Design, e-Prescribe, Claims Processing, Integrated Product Solutions, and Consumer Directed Health Plans. This role encompasses talent management, maintaining processes and procedures, and serving as first tier support for escalated issues. The position also provides project support for new and existing clients, including contributions to clinical program initiatives. Responsibilities Lead, prioritize, and delegate tasks across the Benefit Configuration team, providing clear direction, setting measurable performance expectations, and...

Overview As a Level 3 iSOC Coordinator, you will take on advanced responsibilities, managing real-time interactions and interventions during critical security events. Building on your expertise from previous levels, you will handle live audio communication with individuals at monitored sites, using two-way systems to prevent security breaches, manage incidents such as trespassing, and de-escalate potential threats. Your ability to think quickly and communicate with authority will be key to resolving incidents in real time. This role demands a high level of skill in alarm verification, video monitoring, and rapid decision-making, all while maintaining clear and direct communication with customers and emergency personnel. As a Level 3 Coordinator, you will not only respond to alarms but also provide solutions by directly addressing security violations. This position allows for greater responsibility and impact in a fast-paced, technology-driven environment, as you continue...

The Card Operations team is responsible for all aspects of the UMB card programs. This includes customer loyalty programs, card fraud claims processing, card plastics design and inventory, collateral, card product and program set-up, card network relationships, etc. We are also responsible for ensuring the TSYS TS2 system is configured appropriately to support credit and debit card programs for UMB Consumer, Commercial and Healthcare lines of business. TSYS TS2 platform configuration includes option maintenance requests, service requests, project requests, UATV and production testing, research and remediation. Card Operations also supports TSYS issue management and cardholder complaints. As the Card Operations Specialist, you will be responsible for supporting UMB Card Operations with responsibility for completing operational duties as assigned to ensure smooth and efficient execution of card support services. A primary responsibility of this role will be supporting the...

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 Supv, Operations - Remote Job Description The Supervisor Operations is responsible for ensuring their team delivers on daily production goals and support of key product offerings (Benefit/Network/FormularyDesign, e-Prescribe, Claims Processing, Integrated Product Solutions, Consumer Directed Health Plan, Medicaid and Medicare plans). This position is responsible for talent management efforts, maintenance of processes and procedures, and providing subject matter expertise for escalated issues or project support. Responsibilities Monitor and manage team workload and capacity, quality metrics, cost, and efficiency to ensure performance guarantees, turnaround times and other internal and external service levels are met...

Overview As a Level 3 iSOC Coordinator, you will take on advanced responsibilities, managing real-time interactions and interventions during critical security events. Building on your expertise from previous levels, you will handle live audio communication with individuals at monitored sites, using two-way systems to prevent security breaches, manage incidents such as trespassing, and de-escalate potential threats. Your ability to think quickly and communicate with authority will be key to resolving incidents in real time. This role demands a high level of skill in alarm verification, video monitoring, and rapid decision-making, all while maintaining clear and direct communication with customers and emergency personnel. As a Level 3 Coordinator, you will not only respond to alarms but also provide solutions by directly addressing security violations. This position allows for greater responsibility and impact in a fast-paced, technology-driven environment, as you continue...