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Assess the impact of crash-avoidance technology on Auto insurance claims. Conduct trend analysis to track changes in claims frequency and severity. Assess the impact of crash-avoidance technology on Auto insurance claims.
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Experience with pharmaceutical data sources such as IQVIA, SHS, Claims, and other syndicated resources; strong understanding of Patient/Claims data (APLD) preferred. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment.
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Assist with the review of monthly GP utilization files (GP rebate claims), 340B | PHS program, GTN accrual summary file, and GTN reporting package. Key Responsibilities Manage GP models, review, parallel calcs, and analyze reporting of programs requiring price reporting, per legislative requirements, including Average Manufacturers Price (AMP), PHS Price, Best Price (BP), VA/FSS (Federal Supply Schedule), Average Sales Price (ASP), non-Federal Average Manufacturer Price (nFAMP), Federal Ceiling Price (FCP), Industrial Funding Fee (IFF) and Unit Rebate Amounts (URA.
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Broad knowledge of secondary pharmaceutical data sources such as Retail & Non-Retail data, Medical & Pharmacy Claims, EMR, Lab Test/Diagnostics, Chart Audits, Patient Hub & Specialty Pharmacy Data, 852/867 EDI and Health System/Payer – Plan hierarchies.
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In-depth knowledge of claims, litigation, arbitration, and trial processes as well as excellent analytical, investigative, and negotiating skills. xperience practicing law as well as claims management (both directly managed and TPA managed claims.
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The Claims Specialist will manage an assigned pending of various types of contract surety bond claims. The position will report directly to the AVP or Senior Manager of Surety Claims and can be a remote position.
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Strong Experience with pharmaceutical data sources such as IQVIA, Symphony, Claims, and other syndicated resources; strong understanding of Patient/Claims data (APLD) preferred. Strong Experience with pharmaceutical data sources such as IQVIA, Symphony, Claims, and other syndicated resources; strong understanding of Patient/Claims data (APLD) preferred.
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Proficient with Microsoft Suite, Adobe Creative Suite, and Veeva Vault PromoMats Proficient in understanding creative assets files and linking medical references to claims structure. Experience managing and maintaining a global library of references and core claims preferably within Veeva PromoMats.
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10+ years of Insurance and/or Reinsurance experience in underwriting, accounting/finance, claims, actuarial, or equivalent client/account management experience preferred. Knowledge of MR US insurance & reinsurance operations, claims & accounting systems a plus.
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Summary: The temporary Claims Eligibility Specialist will work under the supervision of the Billing Unit, focusing on adjudicating and processing fee-for-service claims, as well as managing billing and eligibility inquiries.
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Understanding of health plan operations, including contracting, claims processing, encounter data processing, and Medicaid eligibility and enrollment. The Behavioral Health Senior Manager of Network Relations will report to the Executive Director of Network Management and will work in close partnership with the ABHNJ Behavioral Health Medical Director, Behavioral Health Administrator, CEO, COO, CMO, CFO, and all matrixed growth partners to expand the ABHNJ provider network to effectively manage behavioral health benefits and care.
$190,700 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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This will include but is not limited to distributor notifications and claims, membership management, GPO fees and rebate payments. The Pricing Manager must have pharmaceutical and/or life science experience.
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Works closely with Product Management, UW & Claims to drive flow small and middle market business, build, and execute growth and profit strategies and to secure key accounts, managing account pipeline end-to-end.
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The Claims Specialist will also direct the adjusting and litigation process, strategically partner with counsel, experts and vendors, and drive optimal claim resolutions. The Opportunity Future focused and always one step aheadThe Claims Specialist in the Property team is a critical role in our growing Claims Department, and will be responsible to direct all aspects of file handling on both in-house and third-party administered property claims, with growth opportunity in depth of technical handling and multi-faceted professional development.
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Handle field claims to conclusion, including investigation, documentation, coverage analysis and subrogation/salvage assessment. (AIC, CPSU, SCLA)Previous claims adjusting and estimating experience is preferred.
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claims job in Pennington, NJ
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