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Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..
Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..
Description Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing with the sub-contractor to gather and track associated reporting. The Consumer Service Operations Professional 2 evaluates ..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
Description The Senior Market Development Professional provides support to assigned health plan(s) relative to Behavioral Health RFPs, product implementations and operational support. The Senior Market Development Professional work assignments involve moderately ..
Description The Associate Director, Clinical Pharmacy monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, ..
Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
Description The Health Information Management Professional 2 ensures data integrity for claims errors. The Health Information Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of ..
Job Information Humana Call Center Pharmacy Claims Technician in Troy Michigan Description Job Description Summary The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy ..
Description The Health Information Management Professional ensures data integrity for claims errors. The Health Information Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
Description The Senior Product Manager role is a part of the Pharmacy Product & Growth organization and will be responsible for leading initiatives that help drive value for CenterWell Specialty Pharmacy. ..
Description The Senior Compliance Professional ensures compliance with governmental requirements, specifically risk adjustment coding and medical record document requirements. This role acts as the second line of defense by providing oversight ..
Description Job Description Summary The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations ..
... Humana Lead Product Manager - Healthcare API in Troy Michigan Description ... The Lead Product Manager - Healthcare API (SME) as part of ... Individual will be leveraging previous..
Description The Nurse Auditor 2 will work on the clinical research and development team with coders, clinicians and genetic counselors to develop, implement and maintain clinical lab audit concepts. The Nurse ..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
Job Information Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at Home in Troy Michigan Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business ..
Description The mission of the Physician Performance Insights team is to empower Humana members to make informed healthcare decisions. Our key goal is to ensure transparency and help our members obtain ..
Job Information Humana RN, Senior Stars Improvement, Clinical Professional in Troy Michigan Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be responsible ..
