Healthcare Risk Manager — Risk & Claims Investigation
Direct Jobs
Duke Health in Durham, NC is seeking a professional to manage liability investigations and risk assessments. The ideal candidate will have a Bachelor's degree in a relevant field, a minimum of four years of experience in patient care or health care administration, and desirable certifications in risk management. The role involves educating staff on risk management topics and preparing trend reports while ensuring compliance with regulations. This position provides opportunities for on-call support to staff as needed. #J-18808-Ljbffr Direct Jobs
$41.45 - $59.58 per hour
...Summary : The Clinical Risk Manager is responsible for administering... ...and manages all investigational and evaluation activities associated... ...and patient injury claims. # Manages incident reporting... ...employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a...ClaimsHourly payFull timeWork experience placementWork at office- ...Initiate, coordinate, and manage all investigational and evaluation activities associated... ...liability occurrences and claim pre-litigation files.... ...and complex preventive risk management assessment of processes... ...Certified Professional in Healthcare Risk Management is...Claims
- Elevance Health is seeking an Investigator II for a hybrid role in Durham, North Carolina. This position involves conducting claim reviews, developing healthcare investigations, and building relationships with law enforcement. The ideal candidate will have a BA/BS with...ClaimsWork at office
- ...Clinical Data Manager Join ALO and help shape the future of value... ...ACO by transforming complex healthcare data into meaningful insights... ...archival across clinical, claims, payer, and operational data... ...management Utilization trends Risk adjustment Patient...ClaimsContract workLocal area
- Investigator II Location: Hybrid1: This role requires associates to be... ...you will make an impact Claim reviews for appropriate coding... ...developing enterprise-wide specific healthcare investigations that may... ...with senior‑level management and legal department throughout...ClaimsWork at officeLocal area2 days per week1 day per week
$170k - $200k
...Director, Insurance Risk Cypress Creek Energy is powering a sustainable future, one... ...Energy is seeking a skilled Insurance Risk Manager to oversee its insurance and corporate... ...coverage, cost efficiency, and effective claim settlements to support business growth. The...ClaimsWork at office3 days per week- ...currently an option. Who You Are The Medical Director, Safety Risk Management role will provide pharmacovigilance, regulatory and medical... ...safety for trials or programs Collaborate with study investigator to clarify and gather further understanding of potentially...Work at officeLocal areaRelocation packageFlexible hours2 days per week
$89.4k - $113.99k
...The Risk Manager is responsible for leading and continuously maturing the organization’s Enterprise... ...exposure trends Oversee high level claims activity and loss trends for risk... ...Bachelor’s degree in Risk Management, Healthcare Administration, Business, or related field...ClaimsFull timeTemporary workWork at officeRemote workFlexible hours- ...insure complete accuracy in creating a claim and collecting from a pay source. The Patient... ..., including but not limited to specific managed care contracts, Medicare/Medicaid... ...requested by payer sources, or patients. Investigates denials from insurance companies to...ClaimsWork at office
- ...doctors, hospitals and other healthcare providers who work together to... ...The Population Health Care Manager is responsible for clinical expertise... ...complex and/or rising risk patient populations with a design... ...as patient medical records, claims, and program metric reports...ClaimsTemporary workWork from home
- ...A leading insurance provider is hiring an Auto Claim Professional in Durham, NC. Responsible for inspecting and assessing damages for auto insurance claims, this role requires strong negotiation skills and technical knowledge. The position is fully remote and includes...ClaimsRemote work
- ...competence. Job Summary The Claims Coordinator and Safety... ...enter, process, and proactively manage to conclusion all General... ...timely mannerWorking with others, investigate cause of accidents to... ...and training materialsConduct risk assessments and implement risk...ClaimsHourly payFull timeTemporary workWork at officeLocal areaFlexible hours
$81.07k - $129.71k
...are seeking a Special Investigations Unit (SIU) Investigator... ...as AHFI (Accredited Healthcare Fraud Investigator), CFE... ...Ability to manage multiple cases and deadlines... ...Regulatory Analysis, Risk Assessments, Testifying... ...organizations, and internet sites claiming to represent Blue...ClaimsLocal areaRemote work$63.8k - $105.4k
...1st and 3rd party auto physical damage claims, including both personal and business insurance... ...outcome on every file. Effectively manages work assignments and promptly travel to... ...life of the claim. Partners from initial investigation through final recovery to ensure...ClaimsContract workLocal areaRemote work- ...private dental insurance companies and managed care organizations. This role requires specialized... ...medical-dental cross-coding, electronic claims processing, and the policies and... ...chart notes, and letters of necessity; investigating denied claims, following up on those investigations...Claims
- A leading claims adjusting firm in North Carolina is seeking Independent Insurance Claims Adjusters. This opportunity involves assisting clients in recovering from disasters while providing flexibility and autonomy in your career. With comprehensive training available,...ClaimsFlexible hours
- ...private dental insurance companies as well as Managed Care companies. This position requires... ...medical-dental cross-coding, electronic claims processing and of insurance policies and... ..., chart notes and letters of necessity; investigating certain denied claims, following-up on...Claims
- ...Area: R & D Grifols is a global healthcare company that since 1909 has been... ...‑functional teams and executive management, serving as a trusted advisor on program risk, opportunity, and strategic... ...patterns, PRO/COA, registries, claims/EHR analyses, and economic models...ClaimsFull timeContract workWork at office
- ...Hillenga - State Farm Agent My team's mission is to help people manage the risks of everyday life, recover from the unexpected and realize... ...with policy changes and inquiries. Process insurance claims and follow up with clients on claim status. Coordinate with...Claims
- ...Solutions provides best-in-class Revenue Cycle management to Hospital and Physician Service clients.... ...and recover lost revenue from these denials Investigate the issues and attempt to overturn the denial to get the claims paid What We Offer: Insurance/401k...ClaimsFull time
$20 - $23 per hour
...Consultant for an onsite, permanent position with hybrid work flexibility. The role involves evaluating and resolving life and annuity claims, ensuring accuracy and compliance. Candidates should possess a Bachelor's degree and 1+ years of related experience, with strong...ClaimsHourly payPermanent employment- IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth...Claims
- ...Research Institute in Durham, NC is seeking a Risk Management professional to coordinate investigational activities associated with claims. This position involves analyzing... .... Join us to make a meaningful impact in healthcare. #J-18808-Ljbffr Duke Clinical Research InstituteClaims
$235k - $250k
...Description Company: Well is a healthcare innovation company with the... ...of the company and whose management is passionate about the employees... ...on cost benchmarking and risk prediction models. Operations... ...healthcare quality measures, claims data, and ROI calculations....ClaimsFixed term contract$20 per hour
...textiles, and documents for residential and commercial insurance claims. Compensation: $20.00 per hour For over 25 years, steady... ...the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee...ClaimsHourly payFor contractors- ...& Grievance Specialist to support the review investigation and resolution of healthcare-related appeals grievances claim disputes and coverage determinations. This role... ...comfortable working in a fast-paced environment managing multiple cases conducting detailed research...ClaimsFull timeRemote work
$192k - $264k
About This Role: As the Director of Quality Risk, Auditing and Governance, you will lead... ...Biogen’s comprehensive Quality Risk Management, Auditing, and Governance programs. This... ...be cautious of scam recruitment offers claiming to be from Biogen. All legitimate correspondence...ClaimsFull timeContract workTemporary workLocal area- ...delivering high-quality appraisals for auto and heavy equipment claims. Job Responsibilities: Conduct field inspections and... ...schedules and flexible workload. Support from a dedicated claims management team. Opportunity to work with an established leader in...ClaimsFor contractorsFlexible hours
- A prominent health institution in Durham, NC, is seeking an Insurance Manager to provide support to its Clinical Risk Management Department. This role, which offers a hybrid work arrangement, encompasses various responsibilities including evaluating risks, managing insurance...
- Duke Health is looking for an Insurance Manager to lead the clinical risk management efforts. The role includes managing professional liability insurance programs, evaluating risk financing trends, and providing consultation on insurance issues. Candidates should have a...Relocation package
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