is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including... case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company...
and complies with the Walgreen Co. Pharmacy Code of Conduct. Performs duties as assigned by Pharmacy Manager, Staff Pharmacist... and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered...
. Collaborates effectively across teams, stakeholders, and partners (e.g., UW Support, Claims, Actuarial, Directors of Underwriting... in GRS North America). Mentors junior underwriters and new hires (not as a line manager). May analyze department...
(e.g., Analytics Hub/Claims Analytics support in onboarding new users both internal and external..., etc.). Other Responsibilites Include Resolve client issues at appropriate levels and inform relationship manager and other team members...
generation, margin achievement, DSO, G&A, SCM, project delivery, client satisfaction, staff use, safety, claims resolution.../Manager. Extensive knowledge of the North America PgM market. Significant prior experience in municipal, provincial, state...
OR Executive Underwriter- MM Complex Property Level. The hiring manager will determine the appropriate level based upon the... Underwriting or Market Facing area OR * High School Diploma or Equivalent and 10 or more years of experience in the Claims...
customer inquiries, deductions, billing disputes and/or past due invoices. File claims for all invalid deductions. Handle... year analyses. Other duties: All other duties & special projects as assigned by direct manager or senior management...
-tower programs (claims core, provider data, interoperability, GenAI UM), ensuring benefits realization, risk control... in executive negotiations. Deep command of payer value chain (claims, network, care management, pharmacy, risk adjustment...
, and maintains records. Checks in and prices merchandise as required or as directed by store manager or communicated by the shift... leader. Performs duties as assigned by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy...
, replacement, or vacation overrides Troubleshoot and resolve billing rejections and subsequently rebill claims to appropriate... management and pharmacy software systems to schedule prescription refills and adjudicate claims Coordinate prescription orders...
, company policies and procedures. Supports the efficient workflow of the pharmacy and assists the pharmacy manager... by workload. Ensures the pharmacy operates in accordance to regulations, company policies and standards. Assists pharmacy manager...
Job Category: Administrative Assistance Job Description: Administrative Assistant - WC Claims and TPA Management... to the SVP, WC and TPA Management Claims Lead. This role is a pivotal position, which assists the team in meeting its key...
(eMaaS), enhanced by advanced AI: agent-driven enrollment and billing, cognitive claims, AI-powered customer experience.... Key Responsibilities Shape Vision: Own the 2-year roadmap for agentified enrollment, cognitive claims, AI-led CX...
managerial and executive staff. The Clinical Revenue Supervisor oversees physician claims billed through hospital outpatient... and long-term enhancements that support business needs. Assists manager with maintaining payer scorecards, creating payer...
, replacement, or vacation overrides Troubleshoot and resolve billing rejections and subsequently rebill claims to appropriate... management and pharmacy software systems to schedule prescription refills and adjudicate claims Coordinate prescription orders...
and quality goals working closely with their assigned Claims Adjudication Manager. This will include reviewing and approving... with their Manager and Director as needed to ensure effective end-to-end administration of claims handling with a focus on an exceptional...
and complies with the Walgreen Co. Pharmacy Code of Conduct. Performs duties as assigned by Pharmacy Manager, Staff Pharmacist... and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered...
and complies with the Walgreen Co. Pharmacy Code of Conduct. Performs duties as assigned by Pharmacy Manager, Staff Pharmacist... and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered...
and discretionary judgment to make decisions independent of manager approval on books of insurance business for which the incumbent... (producers, product lines specialists, Risk Services, and Claims Consulting) as well as our external trading partners. Oversees...
Reports To: Customer Service Manager/Supervisor Department: Customer Service Americas Location: Chicago, IL Pay... management of product return requests, damaged product claims and issuance of customer credits/debits Meet key metrics for order...