Healthcare Insurance Specialist Jobs

Description The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and ..

Description The Pharmacy Development Specialist will be responsible for qualifying and managing new business leads and cultivating prospects and sales. Responsibilities Summary The Business Development Specialist will be responsible for managing ..

Description Job Description Summary Care Management Support Specialists contribute to the administration of care management. The CMSS provides non-clinical support to the assessment and evaluation of members' needs and requirements to ..

Job Information Humana Clinical Pharmacy Lead, Remote in Honolulu Hawaii Description Be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and ..

... looking for an experienced Senior Healthcare Investigator to join its industry ... Qualifications Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 3 years of..

Job Information Humana Medicare Appeals and Grievance Medical Director in Honolulu Hawaii Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..

Job Information Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in Honolulu Hawaii Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior authorization ..

... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..

Description The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices. The Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where ..

... whether services provided by other healthcare professionals are in agreement with ... hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management. ... managed Medicaid, or..

... whether services provided by other healthcare professionals are in agreement with ... whether services provided by other healthcare professionals are in agreement with ... hospitals/ Integrated Delivery Systems, health..

Job Information Humana Pharmacy Claims Specialist, Remote in Honolulu Hawaii Description Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues. ..

Description The UM Specialist /UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically ..

Job Information Humana Medical Director - S. Florida in Honolulu Hawaii Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..

Job Information Humana Senior Integration Specialist - Cloud in Honolulu Hawaii Description The Senior DevOps/Cloud Solutions Engineer Enables the automation of software code deployment by eliminating functional silos existing between development ..

Job Information Humana Medical Director - Medicare Pharmacy Appeals in Honolulu Hawaii Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..

... of services provided by other healthcare professionals in compliance with review ... whether services provided by other healthcare professionals are in agreement with ... hospitals/ Integrated Delivery Systems, health..

Job Information Humana Care Management Support Specialist in Honolulu Hawaii Description A day in the life of a CMSS would consist of being aligned to one of over 6 different tasks ..

Job Information Humana Special Investigations Professional / Lab Investigator (Fraud, Waste & Abuse) Remote/Virtual in US in Honolulu Hawaii Description The Fraud and Waste Professional 2 conducts investigations of allegations of ..

Job Information Humana Pharmacy Special Investigations Professional (Fraud, Waste & Abuse) Remote in US in Honolulu Hawaii Description The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and ..

An innovative and fully integrated health system is recruiting for BE/BC Family or Internal Medicine physicians for two practice locations. u00a0 * Employed, full-time position * Outpatient Primary Care practice * ..

Job Information Humana FP&A Lead, Medicaid Market in Honolulu Hawaii Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina Medicaid ..

Job Information Humana Vulnerability Remediation Specialist (Remote) in Honolulu Hawaii Description The Systems Engineer 2 is responsible for design, analysis, configuration and maintenance of complex systems software solutions, based on a ..