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The Robotic Process Automation (RPA) Developer will deliver the automated processes within a cross-functional, collaborative team and follow an Agile delivery methodology. Serve as a practitioner in Robotic Process Automation tools (BluePrism), to translate business needs into RPA solutions and automations.
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Class action defense, including antitrust, consumer fraud, civil RICO claims, ERISA, mass torts and products liability regional and national class actions. Health care/ERISA litigation, including claims for benefits, fiduciary duty breaches, provider disputes, fraud, and abuse and overpayment recoveries.
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Enters data and assists with compiling reports and analysis on the grievance and appeals process. Collaborates with professionals, health plan departments such as Claims and Medical Management, and the third party administrator staff and legal, as necessary, to investigate and facilitate resolution of individual grievances and appeals.
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Coordinates external case reviews requested by enrollees, including preparing and submitting documentation according to regulatory requirements and tracking external reviews throughout the process.
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Will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing. Work with provider reimbursement tools, collaborate with Claims Operations, Utilization Management, and Network Management to setup pricing methodologies.
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This position is located in Spartanburg, SC. The Process Control Engineer develops and maintains control systems (DCS and PLC) for real-time, on-line control of production processes. Auriga Polymers Inc., a wholly owned subsidiary of Indorama Ventures PLC is seeking a Process Control Engineer to join our global innovation team.
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The Peer Specialist will perform a wide range of tasks to assist peers of all ages, from young adult to old age, in regaining independence within the community and mastery over their own recovery process.
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As a member of the Risk & Regulatory Advisory team, you will advise financial institutions on a broad range of credit risk management topics including organization and governance; credit process optimization; risk rating model design, build and implementation; credit regulatory assessments; and Current Expected Credit Losses (CECL) process and tools.
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At Thermo Fisher Scientific, our Practical Process Improvement (PPI) Business System is designed to coach, facilitate, and grow the continuous improvement culture throughout the organization – it’s Thermo Fisher Scientific’s path towards operational excellence.
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Through a highly effective Investment Process, they provide solutions across all product platforms and asset classes - equity, fixed income and alternative investments including structured products and specialty assets - through a comprehensive due diligence and oversight process for client portfolios.
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Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 09/23/2024 Duration: Ongoing Employment Type: Staff Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health.
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Manage the entire ocean import process, ensuring compliance with US Customs regulations and company SOPs, and maintain high standards of efficiency and accuracy. Assist in identifying and implementing process improvements to enhance operational efficiency and boost customer satisfaction.
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MRC leads execution of first-line business risk and compliance programs that include vendor and third-party risk management, business continuity and resiliency, business process modeling, internal controls over financial reporting, and trading compliance, among other core areas that promote effective risk management and resilience of the Group’s critical processes.
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The Reliability Manager assists to improve the reliability and quality of product design and manufacturing process. Experience with failure analysis for TEM/SEM products, including optical microscopes (metallurgical and stereo), X-ray, Raman spectroscopy, FTIR, OBIRCH, etc.
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Coordinate and manage the process of collecting and entering accurate project data into databases (e.g., Deltek Vision, Microsoft Dynamics CRM, and OpenAsset), including managing project and resume files in InDesign.
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claims process jobs Company: Metroplus Health Plan in Jersey City, NJ
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