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
$215k - $295k
...patient into its clinical development programs. The Director/Senior Director of COA Strategy... ...inform necessary claims, support market... ...colleagues in policy to help inform strategies... .... Strong project management skills including... ...and Armed Forces Service Medal Veterans, or...SeniorPolicyClaimsFull timeWork at officeLocal area$182k - $346k
...Clinical Research Director AbbVie's mission... ...and products and services in our Allergan Aesthetics... ...: Manages the design and implementation... ...per corporate policy and regulations... ...the time of this posting based on the job grade... ...or communication claiming to be from AbbVie,...SeniorPolicyClaimsWork at officeImmediate startRemote workMonday to Friday$80k - $95k
...Senior Account Manager - Commercial Lines Hybrid Preferred: 1-2... ...If this position is posted as either fully remote... ...accordance with company policy, individuals residing... ...and customer service activities, resolving... ...administration, billing, claims, and coverage analysis...SeniorPolicyClaimsFor contractorsRemote work- ...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
$126.1k - $168.13k
...an in‑house opportunity? The Senior Claims Counsel position with First American... ...to difficult problems, manage their own caseload, oversee... ...evaluate loss under the title policy, assess defenses for the insured... ...this position at the time of posting. Pay is based on a number of...SeniorPolicyClaimsRemote work$65k - $90k
Senior Commercial Line Account Manager (Mid to Large Market Risks) Independent Agency is looking... ...relationship between the service team and insurance... ...analyses Answering client policy and coverage questions Consulting... ...and conducting claim review meetings for selected...SeniorPolicyClaims- ...the diagnosis and management of diseases of the... ...seeking an experienced Senior Vascular Surgery... ...radiology S&I services appropriately Review... ...coding edits and claim rejections related... ..., CMS, and payer policy updates impacting... ...Submit supporting clinical documentation for...SeniorPolicyClaims
$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
$130k - $160k
Senior Claims Specialist - EPL/Fiduciary AXIS Capital is hiring a Senior Claims... ...Claim Team. This role involves managing primary and excess claims for various AXIS policy forms. The individual will... ...apart for our outstanding client service, intelligent risk taking and superior...SeniorPolicyClaimsWork at office3 days per week- ...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
$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- ...assistance with products and services. Resolves customer... ..., federal, and company policy. Reviews and complies... ...as assigned by Pharmacy Manager, Staff Pharmacist and Store... ...and resubmits) manual claims for third party program... ...in administering clinical services including the...SeniorPolicyClaimsWork experience placementLocal areaImmediate startFlexible hoursAfternoon shift
$60.6k - $120k
...Management Liability Senior Claims Specialist IAT Insurance Group has an immediate... ...claims Follow operational policies and procedures, including... ...performance and customer service standards Prepare reports... ...associated with this posting is $60,600 – $120,000. Actual...SeniorPolicyClaimsWork at officeImmediate startRemote workVisa sponsorship$100k
...full line of products and services designed to meet the unique coverage and claims-handling needs of... ...Business Title(s): Senior Construction Defect Technical... ...VT. This role will be managing three Claims Handlers and... ...claims forms, policies and endorsements, client...SeniorPolicyClaimsFull timeLocal areaRemote work- ...Senior Therapeutic Specialist, Oncology... ...Gilead's products and services to a defined customer... ...information, clinical updates on education... ...National Account Managers, Therapeutic Center... ...federal and company policies, procedures, and... ...Statute, the False Claims Act, PhRMA,...SeniorPolicyClaimsWork at officeWorldwide
$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$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$100k - $113k
As a senior territory sales representative for Progressive Fleet &... ...offerings. In this role, you’ll manage agencies within a specific... ...the agency, underwriting and claims teams. This role will require... ...Progressive's driving standards and/or policy. This position requires a...SeniorPolicyClaimsTemporary workH1bHome officeFlexible hoursNight shift$90.2k - $128.5k
Senior Scientific Liaison II, Hair Color Scientific Valorization... ...anticipate scientific claims enabled by technology... ..., safety, and clinical teams, and interpret results... ...to prioritize and manage multiple projects while... ...Pension Plan. Hybrid work policy: up to 2 days per week...SeniorPolicyClaimsPermanent employmentFull timeWork at office2 days per week3 days per week$118.1k - $155k
...Business Excellence, Asset Management Lead & Content... ...of vendor engagements post contract execution Review... ...DAM, content libraries, claims automation, and modular... ...base salary range for the Senior Manager, Business... ...such, is committed in policy and in practice to recruit...SeniorPolicyClaimsContract workLocal area- 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
$155.2k - $232.8k
...for more information. The Senior Oncology Account Manager is responsible for direct... ...competitive landscape, and clinical developments in oncology to... ...line with the company’s policies, regulatory and legal requirements... ...Preferred Experience Post-graduate business school...SeniorPolicyTemporary workWork at officeWorldwideFlexible hours$59k - $85.1k
...Function: Customer Management Job Sub... ...Technical Customer Service Job Category:... ...Professional All Job Posting Locations:... ...recruiting for a Senior Service Coordinator... ...while delivering clinical and economic value... ...company regulations and policies. Assist in training...SeniorPolicyRemote jobFull timeTemporary workWork experience placementWork at officeLocal area$170k - $240k
...highly skilled and motivated Senior Construction Manager to support one of the most... ...inspections, testing services, and comprehensive quality... ...strategies and responses to claims and change orders. Stakeholder... ...apply. We are dedicated to a policy of non‑discrimination in employment...SeniorPolicyClaimsFull timePart timeFor contractorsWork at officeLocal area$90.2k - $128.5k
...change people’s lives. Senior Scientific Liaison II -... ...future scientific claims enabled by technology innovation... ..., Safety, Analytical, Clinical, and Evaluation... ...Ability to prioritize and manage multiple projects while... ...skill level) Hybrid Work Policy (Up to 2 Days per week...SeniorPolicyClaimsPermanent employmentFull timeWork experience placementSummer workWork at officeImmediate startWork from homeFlexible hours2 days per week3 days per week$85k - $130k
...Job Overview Claims Specialist – Employment Practices Liability & Ancillary Lines with AXIS... ...strategies in accordance with company policies. Collaborate with insureds, brokers, and... ...Experience as a litigator or litigation manager, well‑versed in dispute resolution. Ability...SeniorPolicyClaimsWork at officeShift work3 days per week$106.2k - $167.2k
...product development life cycle. The QA Clinical Quality (CQ) team ensures the safety, rights... ..., government regulations, and company policies. Develop and deliver awareness sessions... ...analysis Process improvement Stakeholder management Ownership & accountability Time...SeniorPolicy- ...most exciting missions in the world! The Senior Technical Account Manager (TAM) is responsible for actively driving and managing the post sales process with Enterprise-level... ...Vulnerability Management, Cloud Security, Policy Compliance, Intrusion Detection Systems IDS...SeniorPolicy
- ...Senior HR Generalist Yona Solutions is a fast-growing... ...of facility support services with a strong mission... ..., and performance management. The ideal candidate brings... ...inquiries related to policies, procedures, and... ...workers’ compensation claims into the system, drafting...SeniorPolicyClaimsWork at office
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