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Serves as the Senior Plan leader and liaison for MHI Service Operations, including: Claims, Configuration Information Management, Enrollment, Contact Center Operations, IT, Provider Configuration Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances, Member Appeals and Grievances, and other departments as required.
$122,430.44 - $238,739.34 a yearExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Exists to manage and enhance computerized claims processing and information management systems in order to assure timely and accurate Medicaid and Child Health Plan Plus (CHP+) claims processing and payments in an environment of rapid policy change.
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Health plan payer or health system experience (5 years minimum) in a payment integrity or revenue integrity related role required. The Payment Integrity Edits Manager is a Registered Nurse (RN) with active, unrestricted licensure through the Board or Agency charged with providing such licensure in the Auditor's state of residence or RHIA/RHIT/CCS certified through the American Health Information Management Association.
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The Payment Integrity Edits Manager has a sound knowledge base in edit research and development in pre- and post-payment medical claims auditing in conjunction with maintaining a robust quality assurance program.
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Partner with the business and engage the HEMAR Global Market Access Team, Health Economics and Outcomes Research (HEOR) Team, and Clinical Affairs leaders to influence the short and long-term clinical and marketing plans to ensure the evidence needs of economic stakeholders are met for Philips products/solutions.
$150Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Here are some of our offerings: Competitive salary based on experience and qualifications Medical, dental, and vision coverage Allstate pension plan and 401(k) savings plan Ayco financial coaching Spring Health mental and emotional wellbeing resources Paid parental leave Adoption reimbursement Paid time off Tuition reimbursement Wellness incentives Notes The preceding description is not designed to be a complete list of all duties and responsibilities.
$59,250 - $86,900 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Develop and manage quality assurance plan for all retrospective database studies conducted in house by the HEOR team. PhD preferred, minimum MS in Statistics/Biostatistics, Health Economics, Epidemiology required.
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UPMC Health Plan Actuary is seeking an Actuarial Analyst II to join their Pharmacy team! This position applies knowledge of mathematics, probability, and statistics in order to identify issues, and gather and analyze data on a wide variety of topics affecting the financial performance of the health plan May represent the department on corporate projects.
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BenefitsCompetitive salary, matching 401K retirement plans, fully-funded Pension plan, bonus programs, paid holidays, vacation days, personal days, paid sick leave, and a comprehensive health care plan.
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Litigation Management - Proactively develop and execute a strategic file management plan that achieves optimal file resolution, including as appropriate: research and recommendation of counsel; litigation and resolution strategies; management of loss adjustment expenses; engagement of appropriate experts; use of proper settlement and release terms.
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Claims Examiner I is responsible for reviewing and processing medical, dental, vision and electronic claims in accordance with state, federal and health plan regulatory requirements, department guidelines, as well as meet established quality and production performance benchmarks to include research and review of applicable documentation.
$33,280 - $47,271 a yearFull-timeExpandApply NowActive JobUpdated 21 days ago - UpvoteDownvoteShare Job
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Certified Health and Safety Technician (CHST), Certified Safety Professional (CSP) or Certified Mine and Safety Professional (CMSP) certification strongly preferred. Follow up with the corporate insurance department as regards to high value insurance claims, to ensure that documentary information has been collected, secured, and preserved so that claims will be resolved in a timely manner as required at the local office.
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The Human Resources/Benefits Manager is responsible for coordinating and managing the day-to-day operations of our team member benefits programs (group health, dental, vision, short-term and long-term disability, workers compensation, life insurance, flexible spending plans, flexible spending plan, retirement plans, etc.
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Arlo’s founding team has extensive experience in claims analytics, data science, benefits administration systems, and health plan underwriting. As a technology-forward MGU (managing general underwriter), we use modern data science techniques to help health plan architects design novel health plans and leverage value-based care.
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VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
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