13 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,...

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...

Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere. Apply today! Job Details This role is responsible for researching and reconciling customer disputes, payments, credits, invoices, and contracts to reflect the proper status and balance of the customer's account receivable and ensure payment recovery on invalid short payments/claims. Disputes are researched utilizing SAP, Customer and third-party websites and external and internal departments. Position handles significant high volumes which requires fast decision making and a self-starter requiring minimal supervision. Analyze historical customer payments and disputes to derive issues, trends and root cause analysis...

POSITION SUMMARY: The Program Director will be responsible for the development, management, and promotion of pickleball programs; the organizing and scheduling of all programming including clinics, leagues, camps, open play, and tournaments. This position reports directly to the General Manager at the N. Charleston, SC location. TASKS AND RESPONSIBILITIES: Organize, schedule, administer and promote leagues, round robins, drop-in/open-play, ladders, social events, tournaments, lessons and all other pickleball programming. Responsible for all club and pickleball activity programming, including developing and promoting pickleball programs for all age groups. Organize, schedule, and manage daily operation of 5-6 leagues/quarter or more. Manage and monitor court schedules to maximize usage. Promote club memberships to all potential prospects. Responsible for the supervision of the pickleball teaching professionals and coaches including scheduling pickleball clinics...

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...

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...

Job Description: Application Window: Ongoing (evergreen position) Target Hiring Date: Ongoing (evergreen position) About the Role As a Senior AML Investigator, you'll work remotely to provide expertise in detecting suspicious financial activity, ensuring regulatory compliance, and performing quality control. You will lead investigations, supervise junior analysts, and collaborate with clients to manage financial crime risks. This role offers the opportunity to work independently while making key decisions in a fast-paced, dynamic environment. Work Arrangement This is a remote, work‑from‑home opportunity for candidates currently residing in one of our eligible states: Arizona, Florida, Georgia, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, or Texas. Please note: Remote work flexibility is not guaranteed long-term and may be subject to change based on company needs. Company-Provided Training (First Three Weeks) Virtual...

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...

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...

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...

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...