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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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Interface with Third Party Risk Management group where appropriate. The MTA IT Cybersecurity organization, is responsible for identifying, developing, implementing, and integrating cybersecurity-related processes internal and third-party supplier organizations to reduce the operational risks, reputational risks and financial risks.
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The ideal candidate will leverage expertise in high-level complex SaaS sales in supply chain risk, vendor risk management, and/or third-party risk management. Familiarity with Supply Chain Risk Management, Governance, Risk & Compliance, and Third-Party Risk Management.
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External reviewers include New York State (Fair Hearings), Centers for Medicare and Medicaid Services (CMS), Independent Review Entities and Quality Improvement Organizations. Investigates and reviews routine and complex situations and underlying issues, analyzes and solves problems, focusing primarily on issues of medical necessity, quality of care, long term services and supports, etc.
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Advising and assisting the newly acquired entity in designing and implementing Cybersecurity framework(s); including but not limited to, vulnerability management, third-party risk assessment, training & awareness, cybersecurity incident response plan, and threat monitoring.
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Creation and implementation of a JavaScript based connector that enables TRIRIGA to interface with third-party sensors for tracking utilizations. Support Polymer based web-based Applications for TRIRIGA using Google Polymer based and web based, JavaScript, and HTML. Implementation and support a middleware data loader based on Python to translate and transfer data.
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Have a working knowledge of and be able to support all GRC capabilities such as cyber risk management, third-party risk management, security training and communications, and our compliance program.
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The team is skilled in all phases of risk and resilience, from understanding global regulatory requirements and leading practices to designing and implementing right-sized capabilities throughout the business, technology/ cybersecurity, and third-party risk management lifecycles.
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The CGR team has responsibility for the following functions: Policy Governance, Risk Assessment, Compliance Training, Compliance Risk Assessments, Third Party Risk Management, and Board Reporting.
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Responsible for Third Party Risk Management Program including onboarding and renewals. The Security GRC Analyst is responsible for the facilitation, operation, and maintenance of Governance, Risk & Compliance efforts to support our Information Security and Compliance goals and objectives.
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In this role, the successful candidate As part of the Pharmacy Business & Analytics (PBA) team, this position monitors and manages Third Party Administrator (TPA) split-billing software reports to ensure regulatory compliance and optimization of 340B Program revenue.
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This multifaceted reinsurance claims position involves both ceded and assumed reinsurance responsibilities, with an emphasis on third-party reinsurance reporting, billing, and collection activities for Argo’s US Property, Casualty, and Professional Liability claims.
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This position is responsible for supporting the Government's professionals in all aspects of litigation support and e-discovery processes, including providing project management, Electronically Stored Information (ESI) intake, data analysis, early case assessment, document production, and liaising with third-party vendors.
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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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File briefs in state supreme courts on cutting-edge constitutional issues, either as amicus or as co-counsel for a party, and participate in oral argument as appropriate. In just over a year of existence, the SSCI has already served as co-counsel for a party or an amicus curiae in 24 cases spanning 18 states.
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third party jobs Title: quality manager Company: Jbs Usa in New York, NY
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