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Description The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly ..
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Description The Senior Health Information Management Professional ensures data integrity for claims errors. The Senior Health Information Management Professional work assignments involve moderately complex to complex issues where the analysis 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 Claims Review Representative 3 makes appropriate ... based on strong knowledge of claims procedures, contract provisions, and state ... state and federal legislation. The Claims Review Representative 3..
Job Information Humana Pharmacy Claims Specialist, Remote in Newport Rhode ... Rhode Island Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy..
Description The Manager, Fraud and Waste, Genetic Counseling provides clinical support for investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste, Genetic Counseling works within specific guidelines ..
Description The Medical Coding Coordinator 2 will process and apply the appropriate Code Edit claim payment reductions and denials based on software recommendation. The Medical Coding Coordinator 2 reviews submitted medical ..
... through the placement of various insurance products and policies. They help ... Associate Brokers primarily interact with insurance carriers and their intermediaries, negotiate ... their intermediaries, negotiate and place..
Description The Medical Coding Coordinator 2 extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical ..
Description The Pharmacy Claims Professional 2 monitors and ensures ... ensures appropriate adjudication of pharmacy claims. The Pharmacy Claims Professional 2 work assignments are ... of action. Responsibilities The Pharmacy..
Description The Health Information Management Professional ensures data integrity for claims errors. The Health Information Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
Job Information Humana Pharmacy Desktop Auditor (Claims Professional 2) in Newport Rhode Island Description The Humana Pharmacy Solutions traditional Desktop Audit team oversees and manages multiple aspects related to reviewing pharmacy ..
Job Information Humana Medical Claims Processing Representative 2 in Newport ... Rhode Island Description The Medical Claims Processing Representative 2 reviews and ... and adjudicates complex or specialty claims, submitted..
Description The Claims Processing Representative 2 reviews and ... and adjudicates complex or specialty claims, submitted either via paper or ... via paper or electronically. The Claims Processing Representative 2..
Description This Actuarial Analyst 2 role on the Specialty Benefits team will take ownership of our Dental and Vision commercial group (100 lives) renewal reporting and the dental trend analysis. 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 Professional 2 is responsible for ... maintaining guidelines. Responsibilities The Pharmacy Claims Professional 2 analyzes and answers ... and answers inquiries regarding pharmacy claims adjudication, including..
Job Information Humana Insurance Product Management Representative 2 in ... Newport Rhode Island Description The Insurance Product Management Representative 2 Manages ... Product Management Representative 2 Manages insurance product offerings..
Description The Senior Health Information Management Professional work assignments involve moderately complex to complex issues to work with various teams to develop business requirements, track and monitor the success of the ..
Description The Claims Review Representative 4 (formerly Team ... based on strong knowledge of claims procedures, contract provisions, and state ... state and federal legislation. The Claims Review Representative 4..
