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Strong knowledge of key laws and regulations impacting the pharmaceutical industry including the PhRMA Code; Federal Food, Drug, Cosmetic Act; Anti-Kickback Statute; False Claims Act, OIG/DOJ Guidance; Foreign Corrupt Practices Act; and federal and state transparency and disclosure laws.
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In this role you will collaborate with our team of pricing, claims, distribution, product management, underwriting and claims experts to sell and deliver consulting and technology solutions to our personal lines insurance clients.
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Conduct depositions, mediations, arbitrations, hearings, and trials related to workers' compensation claims. Juris Doctor (JD) degree from an accredited law school. Seeking a dedicated and experienced Workers' Compensation Attorney.
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Primary: Review and disposition Non-Conforming Material (parts), Deviation Requests, and Waivers from OEM and supply base, as well as relatable reviews supporting Aftermarket MRO. Work includes ability to review fit, form, function, interchangeability, health, safety, intended use, weight, appearance and classification (major vs minor) based on provided / requested technical information.
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Such disagreements and/or claims may be resolved through an impartial hearing, a formal method in which the parties present and refute evidence before a hearing officer. OATH also houses the Center for Creative Conflict Resolution which provides mediation and restorative justice support to City government agencies and the general public, and the Administrative Judicial Institute, a resource center that provides training, continuing education, research and support services for administrative law judges and hearing officers.
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Understanding of Healthcare & Insurance claims analytics (SAS, R, Python) This role will be hands-on with building and implementing predictive models for healthcare organizations with strong technical skills using SAS, SQL, R, Python, Power BI, etc.
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Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses' analysis. Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and/or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.
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Associate Director of Nursing (ADN), Clinical and Community-Based Services will oversee a team of Transitional Care Nurses (TCNs) responsible for the coordination, management and disposition of patient referrals to the Certified Home Health Agency (CHHA.
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Litigation management of Cyber and Technology Errors and Omissions (E&O) liability claims including: retention of counsel, strategy planning and analysis that may include alternate dispute resolution, direct negotiations and/or trial management.
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Collaborate with various functional areas across the organization, including underwriting, claims, risk control, actuarial, legal, marketing, and regulatory compliance in creating products. We are seeking an AVP - Product and Regulatory Counsel reporting to VP - Associate General Counsel.
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Monitors and works Hold buckets on Athena Dashboard, assists Professional Reimbursement Department on resolving open claims. Addresses concerns and/or complaints from patients, vendors, and staff members; escalates to Clinic Manager as needed.
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Provide timely and accurate reporting with internal and external support including, but not limited to, claims processing, return to work, light duty assignment, closure of claims, and resolving discrepancies as needed.
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This is a full-time on-site role as an Auto Damage Adjuster at Blue Star Brothers in the New York City Area. The Auto Damage Adjuster will be responsible for handling car insurance claims, property damage assessments, and analyzing auto claims to determine coverage eligibility, along with basic clerical work, such as filing, scheduling, and assisting with parts order.
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If so, we are looking for a Full or Part-time Materials Engineer/Materials Scientist with broad design and manufacturing expertise to join our national Materials Science practice group to provide investigation, analysis, reports, and testimony where technical and scientific answers are needed to help resolve civil and criminal litigation and insurance claims.
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Experience working with healthcare data, including but not limited to eligibility, claims, payments, and risk adjustment datasets. Amazon Redshift, Google BigQuery, and Snowflake. Apache Beam and Apache Spark.
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claims complaints disposition jobs Company: Metroplus Health Plan in Newark, NJ
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