The Director of Claims Integrity and Analytics is responsible for leading the comprehensive management of claims payment processes, ensuring the accurate and timely execution of claims. This includes overseeing third-party administrator (TPA) performance, maintaining the integrity of payment configurations, and managing claims appeals. The position requires collaboration with internal teams and external partners to ensure that claims payments are processed in accordance with contractual agreements and regulatory requirements. The role will also focus on optimizing the medical payment process to reduce costs and improve outcomes, while ensuring compliance with applicable regulations to prevent fraud, waste, and abuse (FWA). A strong understanding of healthcare policies, payment methodologies, and advanced analytical skills are essential.
Key Responsibilities:
Claims Payment Integrity:
Claims Operations & Delegation Management:
Claims Appeals & Audits:
Management & Leadership:
Strategic Oversight & Continuous Improvement:
Qualifications:
Education:
Experience:
Other Skills:
...of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Wayfair. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is...
Dietary Server Make a Difference in the Lives of Seniors! Pomeroy Living, a state-of-the-art assisted living community, is seeking compassionate and dedicated Dietary Aides to join our team. Responsibilities: Assist in the preparation of meals, as assigned by...
...A privately held New York real estate investment company is looking for a General Manager. The successful candidate will be responsible for commercial office buildings totaling 1,000,000 plus sq. ft.. Knowledge & Experience ~ A minimum of ten (10) years working in...
Driller with at least 3 years of drilling experience on air rotary drill, downhole hammer consolidated formation, to drill water wells residential and commercial. Must be an experienced driller with minimum class B CDL Will help relocate and provide housing to the...
Position Overview RE/DONE is seeking a passionate and driven Part-Time Sales Associate to join our team. As the face of our brand in-store, youll play a key role in creating exceptional shopping experiences, building client relationships, and bringing our mission...