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Description The Credentialing Assistant 3 obtains and reviews documentation to determine status in a health plan. The Credentialing Assistant 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. ..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
Description The Bilingual Claims Research and Resolution Representative 2 address customer needs which may include complex financial recovery questions, and resolving issues. Records details of inquiries, comments or complaints, transactions or ..
Description . Responsibilities The Process Improvement Lead researches best business practices within and outside the organization to establish benchmark data. This individual collects and analyzes process data to initiate, develop and ..
Description The Business Support Coordinator 2 follows established procedures and guidelines to provide timely and effective clerical support to an office, business unit, department, or other organization group. The Business Support ..
Description The Supervisor, Grievances & Appeals manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Supervisor, Grievances & Appeals ..
Description The Associate Director, Payment Integrity uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
Company Name: Kroger Specialty Pharmacy Position Type: Employee FLSA Status: Non-Exempt POSITION SUMMARY Perform functions to dispense prescription medications to patients in keeping with providers' prescription orders, provide expert counsel to ..
Description Humana is looking to add new associate to the PrePay Audit team in San Juan, PR. This Claims Review Representative 3 opportunity is 100% work-at-home position for the San Juan, ..
Job Information Humana Claims Review Representative 3 - Remote PR only in San Juan Puerto Rico Description The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of ..
Description The Senior Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted ..
Job Information Humana Market Leadership Advisor (Fully Bilingual English/Spanish, Managed/Health Care Industry) San Juan, PR in San Juan Puerto Rico Description The Market Leadership Advisor manages the development, operations, and results ..
Job Information Humana Manager, Care Management/HMS (RN FULLY BILINGUAL with supervisory and Clinical exp) San Juan, PR in San Juan Puerto Rico Description The Manager, Care Management leads teams of nurses ..
Job Information Humana Subrogation Professional 2 Remote/WAH in USA in San Juan Puerto Rico Description The Subrogation Professional 2 identifies, investigates, and collects recoveries from third parties who are legally responsible ..
Description The 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 works on ..
Job Information Humana Subrogation Professional 2-WAH in US in San Juan Puerto Rico Description The Subrogation Professional 2 identifies, investigates, and collects recoveries from third parties who are legally responsible for ..
Job Information Humana Associate Director, Provider Payment Integrity | Prepay Operations in San Juan Puerto Rico Description The Associate Director, Payment Integrity uses technology and data mining, detects anomalies in data ..
Job Information Humana Market Leadership Advisor (Managed/Health Care Industry) San Juan, PR in San Juan Puerto Rico Description The Market Leadership Advisor manages the development, operations, and results of a health ..
Description The Manager of Sales Administration provides direction and leads office staff by recruiting, selecting, orienting, and training employees as well as working closely with the sales team and Director. The ..
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 ..
