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Interfaces with the HRA/TDC on-site Professional Liability Investigators: reporting potential claims as well as cases of concern by preparation of preliminary reports, and determination of priority of investigation given risk management assessment.
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Works to ensure the company's compliance with pharmaceutical laws including the Anti-Kickback Statute, False Claims Act, PhRMA Code and FDA regulatory guidelines. The Associate Senior Counsel, Legal Operations - Commercial reports to the Assistant General Counsel, Legal Operations - Commercial and will be primarily responsible for providing counsel specific to the company's pharmaceutical regulatory needs, including sales and marketing, scientific exchange and other medical activities, monitoring, co-promotions, and FDA standards for a variety of pipeline and in-line assets.
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This role reports to the SVP & Chief Legal Officer and works closely with the VP, Claims Counsel as well. The Senior Surety Claims Counsel is responsible for reviewing, investigating, resolving, and negotiating performance bond defaults, payment bond claims, subdivision, and commercial bond claims.
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Perform claims resolution or medical billing and appeals or claims denials in Athena within the last two years. Overview: Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty/multi-site healthcare organizations in the U.S.
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Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (e.g., Facets, QNXT, etc.) Seven (7) years of medical claims investigation or data mining, 5 years in a leadership role.
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The RoleSenior Claims Specialists at Willis Towers Watson drive proactive adoption of risk mitigation strategies and positive outcomes for clients who experience losses. Advocate for timely, optimal resolution of claims, including escalation/negotiation with claim service providers on disputed claims.
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JD degree and 7+ years of legal practice including a minimum of 4 years focused on providing counsel to the pharmaceutical industry. Strong knowledge of FDA regulatory and fraud and abuse law. A global pharmaceutical company located in NorthNJ seeks an Associate Senior Counsel, Legal Operations - Commercial who will be responsible for providing counsel specific to the company's pharmaceutical regulatory needs.
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Try and/or arbitrate cases and prepares motions in liminie and summary documents Draft post-trial motions Prepare for and participate in appeals Provide legal opinions to claims clients Investigate and pursue subrogation litigation as appropriate Manages projects.
$82,000 - $146,125 a yearFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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For 28 years, we have continued to commit ourselves to the utmost degree of integrity and professionalism specializing in all aspects of insurance defense investigations to include; claims investigations, SIU investigations and Vendor Management Programs.
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Deep background in medical billing, coding, or auditing of insurance claims and medical records. Clear documentation of inconsistencies with claims billed vs health plan payments. You will be responsible for reviewing and analyzing medical claims, patient medical records, and automatic claim audit results to help train our machines that will deliver automated audit results.
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Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards. Assists in creation of reports, attends, and presents at Plan committee meetings (Grievance, SIC, etc.
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Group Insurance business processes, e.g., onboarding, underwriting, pricing, enrollment, contracting, billing, administration, and claims. Group Insurance products, e.g., Life, Disability, Absence, Medical Stop Loss.
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The Immigrants' Rights/International Human Rights Clinic provides direct representation in matters including asylum and Convention Against Torture claims, deferred action labor enforcement (DALE) petitions, human trafficking and VAWA cases, detained and non-detained cases before immigration judges, and appeals at the Board of Immigration Appeals and the Third Circuit.
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Responsibilities The primary purpose of the Inpatient Coding Data Quality Auditor/Educator is to ensure the consistent processing of claims and collection of data to optimize DRG reimbursement and produce quality data that accurately reflects the severity and intensity of hospital inpatient services.
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EQ offers a comprehensive product set, including transfer agency services, cap table management, equity compensation services, proxy solicitation and advisory services, private company solutions and bankruptcy claims administration services.
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claims job Company: Metroplus Health Plan in Newark, NJ
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