39 ltc claims operations manager jobs found

Become a part of our caring community and help us put health first The Director, Payment Integrity uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. The Director leverages technology and the clinical and coding expertise of their associates to identify potential overpayments to be substantiated via review of medical records. The Director contributes to the investigations of fraud, waste and abuse. The Director requires an in-depth understanding of how organizational capabilities interrelate across the function or segment. The Clinical and Coding Medical Record Review Director of Payment Integrity contributes to overall cost reduction, by increasing the accuracy of provider payments in our payer systems, and by ensuring correct claims payment. The Director contributes to overall cost reduction, by increasing the accuracy of provider payments via a complex array of medical record audit programs performed by coders and...

Current Employees: If you are currently employed at any of the Universities of Wisconsin, log in to Workday to apply through the internal application process. Job Category: Limited Employment Type: Regular Job Profile: Finance Director (B) Job Summary: The University of Wisconsin–Madison School of Education is seeking a strategic and forward-thinking financial leader to serve as its Chief Financial Officer (CFO). The CFO is the senior administrator responsible for the School’s overall financial operations, including budgeting, financial reporting, stewardship of educational gift, and research funds, managing financial relationships with UW–Madison and external partners, and ensuring accurate, timely accounting across all cost centers, accounts, and funds. Reporting directly to the Dean of the School of Education, the CFO serves as a key member of the Dean’s Leadership Team. In this role, the CFO offers strategic guidance and financial decision-making support,...

Introduction The Wisconsin Department of Children and Families (DCF), Division of Family and Economic Security (DFES), Bureau of Working Families (BWF), TANF Policy Section is currently recruiting to fill a Program & Policy Analyst / Advanced position. This position may be filled at entry (analyst) level for training purposes, depending on the qualifications of the selected candidate. DCF offers great benefits , personal growth opportunities and work-life balance as a State of Wisconsin employee; and the intrinsic reward associated with serving the children and families of Wisconsin. To learn more about DCF’s complete compensation package, please visit our Total Rewards Calculator! This position may allow hybrid work for a portion of the work schedule up to 95% depending on the employee’s preference and needs of the work unit. Any hybrid work flexibility that may be available will be discussed in more detail in the interview process. For positions...

Summary This position is organizationally located at the Clement J. Zablocki VAMC in Milwaukee, WI as part of the Mental Health Division with the in the VHA Vocational Rehabilitation Service (VHA VR). VHA VR Service includes: Vocational and Educational Assistance, and Compensated Work Therapy (CWT). The Rehabilitation Counselor will provide services based on needs of the veterans and programs at that time. 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. Duties Major Duties of the Vocational Rehabilitation Service Rehabilitation Counselor Include: Provides personal adjustment counseling, therapeutic rehabilitation interventions, and case coordination services. Uses evidence-informed and evidence-based modalities to aid Veterans...

As a beverage-focused application engineer in the Regal Rexnord conveying team, you will serve as the technical liaison for the valued and highly valued customers, district managers and customer service representatives who contact you for assistance. This will involve translating customer drawings, specifications, and detailed requests into product solutions that meet the customer’s application needs. In this role, you will create quote and selection tools, technical sales documents & presentations, and training material to educate end users, distributors and colleagues about our product offering and selection. Application Engineers frequently travel to customer and distributor sites to introduce new products, discuss application solutions, troubleshoot installations, create complete product BOMs, and support our sales team. You will handle technical complaints, which may involve recommending product selections or running chain pull calculations to differentiate between...

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. IT Systems Analyst (Data Analyst) Remote Job Description As a Senior IT Systems Analyst (Data Analyst) , you will play a key role in managing and optimizing system and data integrations that support Prime's clinical vendor hub, PartnerIQ . In this role, you will serve as a technical and analytical subject-matter expert responsible for driving seamless data flow between internal platforms, external vendors, and client partners. You will lead end-to-end integration processes including intake, requirements gathering, source-to-target (STT) mapping, SFTP configuration, environment and data readiness, testing, and ongoing IT service management . This position will support and enhance Prime's internal data pipelines...

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. IT Systems Analyst (Data Analyst) Remote Job Description As a Senior IT Systems Analyst (Data Analyst) , you will play a key role in managing and optimizing system and data integrations that support Prime's clinical vendor hub, PartnerIQ . In this role, you will serve as a technical and analytical subject-matter expert responsible for driving seamless data flow between internal platforms, external vendors, and client partners. You will lead end-to-end integration processes including intake, requirements gathering, source-to-target (STT) mapping, SFTP configuration, environment and data readiness, testing, and ongoing IT service management . This position will support and enhance Prime's internal data pipelines...

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,...

This role is an on‑site position based at our Union Grove, Wisconsin location, five days per week. While the role is primarily on‑site, we offer some flexibility to accommodate occasional scheduling needs. Key Responsibilities The HR Generalist II position will be primarily responsible for supporting the production operations client group, as well as contributing to and executing local and Corporate HR practices and initiatives that will achieve overall business goals in a broad array of HR functions leading hourly: staffing, employee relations, performance management, compensation, compliance, and safety. Supporting HRIS, leaves of absence, payroll, benefits, and other general administration. The position is broad in scope and the successful incumbent will be energized in a hands-on role that is highly productive and able to handle a variety of tasks. A customer-centric mindset with the objective of providing excellent customer experience is vital. Integrity, neutrality,...

At Saputo, we bring good to the table by making high-quality products, investing in our people, and supporting communities around the world . As a top 10 global dairy processor, we value contributions that matter and strive to foster an inclusive, growth-driven work environment. Ready to bring your best? The Health and Safety Specialist in Franklin WI will be a key stakeholder for a new 340,000 square foot conversion facility that is opening in 2023 and will play an integral part of Saputo's strategy to optimize its cheese network in North America. Saputo has a strong history in Wisconsin and are proud to be expanding our footprint in this area. The Health and Safety Specialist develops and drive the overall safety culture. Drives plant safety and risk programs to ensure safe and accident-free work environment. Implements safety concepts to provide an accident-free workplace. Plans and/or delivers programs to train managers and employees in safe work practices and procedures....

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...

About JLG, an Oshkosh company JLG began in 1969, when our founder, John L. Grove set out to resolve growing safety concerns in the construction industry. Since then we have been committed to understanding the challenges and delivering innovative solutions to the access market. We partner with customers to provide quality equipment, training opportunities and trusted support within the access industry. We are a global company, and our products-including mobile elevating work platforms, telehandlers, utility vehicles and accessories-can be found all over the world. YOUR IMPACT To manage assigned sales territory for Specialty products and establish new distribution channels. To develop effective communications and a positive working relationship with distribution partners and ensure a team effort in achieving short and long term goals. Meet or exceed established sales goals. Create and execute sales strategies to achieve set goals. Establish new...

Associate Dean - Agriculture, Manufacturing, and Engineering Technologies (AMET) Division Fox Valley Technical College Job Category Regular Management FVTC Worksite Appleton Main Campus Hours Per Week 40 Fox Valley Technical College celebrates diversity, supports equity and inclusiveness, and encourages individual expression in our workplace. Job Description Summary This position provides leadership and assists in managing division operations and instructional programming of the Division throughout the Fox Valley Technical College District in alignment with the vision, mission, values, and purposes of the organization. The associate dean directly supervises several instructional departments, programs, and related staff within the division and serves in a back-up capacity for the division dean. Job Description Essential Functions and Responsibilities The following duties are primarily performed and are essential for this position. Employees are expected...

Current Employees: If you are currently employed at any of the Universities of Wisconsin, log in to Workday to apply through the internal application process. Position Title: Academic Dept Assoc - Chemistry & Biochemistry Job Category: University Staff Employment Type: Regular Job Profile: Department Assistant Job Duties: The Chemistry & Biochemistry Department at the University of Wisconsin-La Crosse invites applications for an Academic Department Associate. Reporting directly to the Chair of the Chemistry & Biochemistry Department, this position provides administrative support to the department. The Academic Department Associate (ADA) exercises discretion and independent judgment in matters of significance to the operations of the Department and is delegated responsibility for the administrative matters internal or external to the Department. Independently and with minimal supervision, the...

Horizon High School Seeks School Administrator to Lead, Inspire and Transform Lives! The Horizon High School Board of Directors is seeking a school administrator to provide essential educational, curricular, and financial leadership, as well as ensuring the smooth day-to-day operations of our recovery high school. The successful candidate will have at least 2-5 years teaching/administrative experience as well as a deep knowledge of the recovery community and successful programs or 2 years experience in a recovery high school. Horizon HS is a private, non-profit institution located in Madison, Wisconsin. A full job description may be found below. Please submit your cover letter and resume to Mrs. Carole Klopp, Chair, Personnel Committee at ckloppe@horizonhs.org. Horizon High School is a non-profit (501c3) private educational institution, incorporated in Wisconsin in 2004. We are a public-private collaboration and exist with some financial support from local school systems...

SC JOHNSON IS A FIFTH-GENERATION FAMILY COMPANY BUILT ON THE SPIRIT OF OUR PEOPLE. We have been leading with purpose for over 130 years, building iconic brands that win the hearts and minds of consumers – such as Raid®, Glade®, Ziploc® and more, in virtually every country around the world. Together, we are creating a better future – for the planet, for future generations and for every SCJ team member. Join our winning team of Wave Makers and Go Getters and help us write the next chapter in the SCJ story. THE ROLE As the Associate Manager, Project Management – Commercialization, you’ll be at the heart of bringing bold, consumer-loved ideas to life within SC Johnson’s Lifestyle Brands Business Unit—home to iconic, purpose-driven brands like method and Mrs. Meyer's Clean Day. This is your opportunity to champion innovation from the ground up, leading cross-functional teams as products evolve from a spark of inspiration into meaningful experiences on shelves and in homes around the...

At Nestlé Health Science, we believe that nutrition, science, and wellness must merge, not collide. Here, we embrace the intrinsic connections of these three pillars, harnessing their collective strength to empower healthier lives. Our broad product portfolio includes renowned brands like Garden of Life®, Nature's Bounty®, Vital Proteins®, Orgain®, Nuun®, BOOST®, Carnation Breakfast Essentials®, Peptamen®, Compleat Organic Blends®, and more. We also have extensive pharmaceutical expertise, offering innovative medicines that aim to prevent, manage, and treat gastrointestinal and metabolic-related diseases. At Nestlé Health Science, we bring our best for better lives. Our people are challenged to bring fresh, diverse views and make bold moves to empower healthier lives through nutrition. We know brilliant ideas can come from anyone, anywhere. Here we embrace the entrepreneurial spirit and collaborate with teams that champion focused and forward thinking. We are committed to...

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...

Summary These positions serve as Health Science Specialists - Research Study Coordinators within the Research and Development (R&D) Service. The VA Research Program strives to promote Veteran-centered care to improve patient experiences and outcomes across VA healthcare and community settings, and to advance value-driven care by providing Veterans the highest quality care at the lowest financial burden. 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*** NOTE: These are TERM appointments (not-to-exceed 1 year 1 day). Term appointments are non-status, nonpermanent appointments of limited duration (more than 1 year but not more than 4). Term employees are eligible to earn leave and generally have the same benefits as permanent employees including...

At Saputo, we bring good to the table by making high-quality products, investing in our people, and supporting communities around the world . As a top 10 global dairy processor, we value contributions that matter and strive to foster an inclusive, growth-driven work environment. Ready to bring your best? How You Will Make Contributions That Matter Drive cross-functional collaboration by leading coordination efforts among internal stakeholders (Research & Development, Marketing, Regulatory, Quality Assurance, Operations) and external partners (printers, suppliers, customers) to ensure seamless packaging execution. Oversee regulatory compliance strategy for packaging, providing expert-level review of nutrition labeling, imagery, and claims in accordance with FDA, USDA, and third-party certification standards (e.g., Non-GMO Project, Organic), as well as internal corporate policies. Analyze packaging processes and recommend improvements to enhance efficiency...

Current Employees: If you are currently employed at any of the Universities of Wisconsin, log in to Workday to apply through the internal application process. Position Title: Academic Dept Assoc - Chemistry & Biochemistry Job Category: University Staff Employment Type: Regular Job Profile: Department Assistant Job Duties: Th e Chemistry & Biochemistry Departmen t a t th e Universit y o f Wisconsi n - L a Cross e invite s application s fo r a n Academic Departmen t A ssociat e. Reportin g directl y t o th e Chai r o f th e Chemistry & Biochemistry Department , thi s positio n provide s administrativ e suppor t t o th e department. The Academic Department Associate (ADA) exercises discretion and independent judgment in matters of significance to the operations of the Department and is delegated responsibility for the administrative matters internal or external to the Department. Independently and with minimal supervision, the ADA is...

More Results Previous jobAdmissions Outreach Associate Admissions - Admissions CounselorNext job Student Affairs Program Specialist Employer University of Wisconsin Stout Location Eau Claire, WI Closing date Feb 17, 2026 View more categoriesView less categories Specialty Student Affairs Position Type Specialist Hours Full-time Employment Type Permanent Organization Type College / University Apply on website You need to sign in or create an account to save a job. Send job Job Details Current Employees: If you are currently employed at any of the Universities of Wisconsin, log in to Workday to apply through the internal application process. Position Title Student Affairs Program Specialist Job Category Academic Staff Employment Type Terminal (Fixed Term) Job Profile Stdnt Affairs Prog Spec Job Duties POSITION: A 100% academic staff position in Student Support Services beginning Spring Semester 2026. The official title of this position is...