Claims Jobs in Springfield

Description The Pharmacy Claims Lead - Overpayment works on ... moderate to substantial. The Pharmacy Claims Lead will lead the development ... D and review of pharmacy claims containing invalid..

Description The Senior Business Intelligence Engineer (Claims Strategy) solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Senior Business Intelligence Engineer ..

Description The Senior Medical/Financial Risk Evaluation Professional is responsible for supporting the development, implementation and monitoring of medical/financial risk. The Senior Medical/Financial Risk Evaluation Professional work assignments involve moderately complex to ..

Description The Provider Insights & Claims Analytics (PICA) team is a blend of technology, data, and consulting professionals leveraging the latest tools and methods to solve complex business problems. In this ..

Description The Business Intelligence Lead solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Business Intelligence Lead works on problems of ..

Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..

Description The Subrogation Professional 2 iIdentifies, investigates, and collects recoveries from third parties who are legally responsible for paying all or part of medical expenditures for an organization that provides health ..

Description The Network Operations Coordinator 4 maintains provider relations to support customer service activities through data integrity management and gathering of provider data needed for service operations. The Network Operations Coordinator ..

Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..

Description The Senior Clinical Strategy and Practice Professional builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise The Senior Clinical Strategy and Practice Professional ..

Description The Senior Business Intelligence Engineer (Claims Strategy) solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Senior Business Intelligence Engineer ..

Job Information Humana Claims Research & Resolution Representative 2 ... Springfield Missouri Description The Bilingual Claims Research and Resolution Representative 2 ... for well-being Responsibilities The Bilingual Claims Research &..

Description The Associate Actuary analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes unit cost metrics, provides competitive data and ..

Description The Actuary role on the Medical Modeling and Specialty Strategies team within Pharmacy Analytics and Consulting (PAC) is an opportunity to provide analytics in support of Humana Pharmacy Solutions infusion ..

Job OverviewA law firm seeks a Commercial Litigation Associate in Springfield, MO. The ideal candidate will have a minimum of five years of experience in handling insurance coverage disputes within the ..

Description The Bilingual Claims Research and Resolution Representative 2 ... you Come In The Bilingual Claims Research & Resolution Representative 2 ... services in the settlement of claims. Comprised of..

Description The Lead Data Scientist uses mathematics, statistics, modeling, business analysis, and technology to transform high volumes of complex data into advanced analytic solutions. The Lead Data Scientist works on problems ..

... government contract matters, bid protests, claims litigation, and False Claims Act investigations. The ideal candidate ... contract compliance counseling.Handle bid protests, claims litigation, and investigations under the ... and..

Description The Actuary, Pricing MA-PD is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new ..

Description The Senior Claims Research & Resolution Professional manages ... Research & Resolution Professional manages claims operations that involve customer contact, ... contact, investigation, and settlement of claims for and..

Description The Claims Research & Resolution Representative 2 ... & Resolution Representative 2 manages claims operations that involve customer contact, ... contact, investigation, and settlement of claims for and against..

Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..

Description The Senior Business Intelligence Analyst (Claims Strategy) solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Senior Business Intelligence Analyst ..