Senior Manager, Post-Service Claims & Clinical Policy
Horizon Blue Cross Blue Shield of New Jersey - Headquarters
Horizon Blue Cross Blue Shield of New Jersey is seeking a leader in Clinical Coding and Reimbursement Policy for its Newark, NJ office. This role involves managing teams responsible for multiple healthcare programs, ensuring compliance with regulatory standards, and enhancing operational efficiency through process improvements. The ideal candidate will have over 10 years of management experience in healthcare and clinical operations, along with an active RN license. Competitive salaries and comprehensive benefits are offered. #J-18808-Ljbffr Horizon Blue Cross Blue Shield of New Jersey
$80k - $95k
...Description: Title: Senior Account Manager - Commercial Lines Hybrid... ...If this position is posted as either fully... ...accordance with company policy, individuals residing... ...administrative and customer service activities, resolving... ..., billing, claims, and coverage analysis...SeniorPolicyClaimsFor contractorsRemote work- Insurance Office of America seeks a Senior Account Manager - Commercial Lines to manage an assigned book of business, retain... ...support new business. The role emphasizes client service, policy administration, billing, claims, and coverage analysis. Remote work is available...SeniorPolicyClaimsRemote jobWork at office
- ...Professional Billing Senior Analyst functions... ...of the Supervisor/Manager to configure,... ...and understanding policies, procedures, and constraints of the clinical or business operations... ...billing and claims. Documents, communicates... ...working in a service‑oriented environment...SeniorPolicyClaimsTemporary workFlexible hours
- ...underwrites medical stop loss business under applicable regulations and internal policies to protect profitability and the company's reputation. You will assess risk using census data and claims history, quote pricing, negotiate with brokers and clients, and support...SeniorPolicyClaims
$90k - $120k
...are looking for a hands‑on Senior E-commerce Manager who can take ownership of our... ...with all marketplace policies and seller requirements to... ...customer complaints, A-to-Z claims, chargebacks, returns, and... .... Coordinate with customer service, warehouse, and operations...SeniorPolicyClaimsSeasonal work$46.7 per hour
...of insurance, retirement, and wealth management products and services. But we don't stop there we also... ...ensure timely receipt of quotes and policies. Analyze and compare carrier quotes... ...clients in submitting first reports of claims, facilitate prompt response from carrier...SeniorPolicyClaimsWork at officeLocal area$135k - $140k
...healthcare technology and clinical services company with a... ...centric view to medication management, and develop and... ...Comply with all company policies and state and federal... ..., or medical claims Experience working... ...Entrepreneurs. The posted range represents the...PolicyClaimsLive inLocal areaRemote work$60.6k - $120k
...Group has an immediate opening for a Management Liability Senior Claims Specialist that can be located in... ...reported claims. Follow operational policies and procedures, including compliance... ...regulatory, performance and customer‑service standards. Prepare reports, including...SeniorPolicyClaimsWork at officeImmediate startRemote work- The GEO Group Australia Pty Ltd. is seeking a Lead Case Manager in Newark, NJ. This role includes maintaining resident accountability... ...Manager trains Case Managers and ensures compliance with company policies. Candidates should have a Bachelor's degree, CADC certification...SeniorPolicy
- ## Senior Property Adjuster - New York... ...timeposted on: Posted 3 Days Agojob... ...commercial property claims in a variety of... ..., schools, clinics, or hospitals;... ...understanding of insurance policies and policy... ...and fee-for-service procedures,... ...### Ability to manage multiple priorities...SeniorPolicyClaimsWork at officeNight shiftWeekend workAfternoon shift
- Senior Stop Loss Claims & Cost Containment Analyst Westfield Specialty... ...production, and managing claims inventory and... ...healthcare insurance policies, procedures, and regulations... ...exceptional customer service through all... ...networks, bill review, clinical management, specialty...SeniorPolicyClaims
$123k - $167.9k
...implementation and outcomes of Plan Medical and Reimbursement Policy, Clinical Coding, Post-service Claims Reviews and Appeals, development, expansion and... ...and Secondary Editing, Communications, Pharmacy Management, Legal, Quality Management, and Payment Integrity. This...PolicyClaimsLive inLocal area- ...Senior Vascular Surgery Professional Coder... ...the diagnosis and management of diseases of the... .../commercial payer policies This position requires... ...radiology S&I services appropriately... ...coding edits and claim rejections related... ...Submit supporting clinical documentation for...SeniorPolicyClaimsTemporary workWork at officeFlexible hours
$83.29k - $124.93k
...Overview Senior Human Resources Business Partner Newark,... ...consultative human resources services to University Hospital management and staff for assigned... ...staff on issues related to policy and/or union contract... ...as legal and unemployment claims. Provides day-to-day performance...SeniorPolicyClaimsHourly payFull timeContract workTemporary workWork experience placementFlexible hours$75k - $85k
...Summary Vitalief is seeking an experienced Senior Clinical Research Coordinator (CRC) to join our... ..., and investigator‑initiated studies. Manage trials across multiple oncology disease... ...Clinical Practice (GCP), institutional policies, and regulatory requirements. Provide...SeniorPolicyFull timeTemporary workWork at officeRemote workMonday to Friday1 day per week- ...accordance with Company policies and procedures.... ...with products and services. Resolves customer... ...by Pharmacy Manager, Staff Pharmacist... ...resubmits) manual claims for third party program... ...in administering clinical services including... ...condition of promotion to senior technician....SeniorPolicyClaimsWork experience placementLocal areaImmediate startFlexible hoursAfternoon shift
$96k - $132k
Job Description Clinical Development Analyst (Solventum) Company... ...in Health Information Management. - Certified Coding Specialist... ...accordance with its travel policy. This applies to new hires... ...remain alert to fraudulent job postings that claim to represent Solventum and...PolicyClaimsH1bRemote workWorldwideRelocation packageFlexible hours$61.7k - $101.9k
...Operations - Insurance Operations Senior Disability Claims Examiner at Prudential. The Long‑Term... ...for providing excellent customer service while managing an assigned block of around 95 to 1... ...understanding of the Prudential claim system, policies, procedures, contracts, and...SeniorPolicyClaimsContract work$75k - $85k
...Senior Clinical Research Coordinator (CRC) Vitalief is a consulting firm... ...Consulting and Functional Service Provider (FSP) solutions to... ...investigator-initiated studies. Manage trials across multiple... ...Practice (GCP), institutional policies, and regulatory requirements...SeniorPolicyFull timeTemporary workWork at officeRemote workMonday to Friday1 day per week$108.16k - $148.72k
Job Description Title : Senior Specialist - Marketing... ...brand teams to oversee and manage the Marketing &... ...social media activities and claims along with other... ...challenging environment that services multiple global business... ...Mars Responsible AI Policy. Ability to learn and...SeniorPolicyClaimsWork at officeLocal areaVisa sponsorshipRelocation packageShift work- Manager of Clinical Services (RN) - Dialysis/Nephrology Essex County, NJ You became a nurse to make a difference. After years at the bedside, you... ..., digestible guidance for adult learners Support policy development and champion best practices across your region...PolicyRemote workShift workRotating shiftWeekday work
$66.5k - $166.2k
Program Manager, Client Services page is loaded## Program Manager,... ...Full timeposted on: Posted Todayjob requisition... ...pharmacy and medical co-pay claims processing*... ...leading global provider of clinical research services, commercial... ...a zero tolerance policy for candidate fraud....PolicyClaimsFull timePart timeWork experience placementImmediate startWorldwide$86k - $106k
...tail bodily injury and property damage exposures, claims arising under Coverage B of Primary/Excess CGL policies, construction defect, as well as environmental... ...emerging risks; this team has been at the forefront of managing exposures from PFAS, opioids, and other cutting‑...SeniorPolicyClaims- ...to delivering safe, reliable service that gets customers to their... ...Procurement & Logistics Department management. Interacts professionally... ...changes, disputes, and claims in accordance with Federal, State... ...conformance with document control policies. Training Responsibilities...SeniorPolicyClaimsContract workFor contractorsWork experience placementWork at officeFlexible hours
- AXIS Capital in New Jersey is seeking a Senior Claims Specialist - Primary Casualty to manage primary claims for U.S. Primary Casualty policies and evaluate complex liability third-party claims. The role requires onsite presence three days per week, mentoring junior adjusters...SeniorPolicyClaims3 days per week
- ...Employment Practices Liability Claims Professional This is not your average Claims... ...Employment Practices Liability insurance policies ~ Establish, document and execute appropriate... ...Represent the company at meetings with management and business partners, as well as...SeniorPolicyClaimsWork experience placement
$65k - $90k
...Description Job Description Senior Commercial Line Account Manager (Mid to Large Market Risks... ...relationship between the service team and the insurance... ...; Answering client policy and coverage questions;... ...Coordinating and conducting claim review meetings for selected...SeniorPolicyClaims$125.1k - $151.1k
...segment. The Account Manager for the Labor... ...Horizon teams to ensure service delivery,... ...internally with Service, Claims, Provider... ...rating processes and policy renewal practices.... ...g., wellness, IT, clinical). Strong collaboration... ...Horizon at the time of posting. Compensation...PolicyClaimsContract workLive inLocal area- ...insurance firm in Berkeley Heights is seeking an experienced professional to manage public and private D&O claims. The role involves collaborating with internal and external stakeholders, reviewing policies for coverage, and ensuring compliance with regulations. Candidates...SeniorPolicyClaims
- Insurance Office of America is seeking a Senior Account Manager - Commercial Lines to manage a book of business, retain accounts... ...directing the account management team and handling policy administration, billing and claims. Ideal candidates have 5+ years in account...SeniorPolicyClaimsRemote jobWork at office
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