expertise to improve the member and provider experience. Job Description: The Director of Claims and Encounters provides... Director provides strategic leadership, fiscal accountability and operational excellence for the Presbyterian Health Plan...
Claims Director Application Deadline: 13 February 2026 Department: Claims Management Employment Type: Permanent... Insurance Services is looking for a Claims Director for the Excess Claims Management division of Davies north America Insurance...
Coordinator, and Claims Director. Presents findings and recommendations for ongoing, long term resolutions to issues. Identifies...Overview: To research and resolve complex claims issues which cross interdepartmental lines and communicate the...
both on-site and regional site(s) Provide feedback and recommendation to the Claims Audit Supervisor and Associate Director... regulations, and CMS Medicare regulations. Draft Claims Operating Instruction documentation for the Claims Director as assigned...
Overview: To supervise the Medi-Cal Claims Specialists and Examiners. Ensures delivery of highest level of customer... service to the community and its medical providers. Responsibilities: Supervises the Medi-Cal claims specialists...
and related reports for the Director’s revie Collaborates with Claims Customer Service Manager to identify provider abrasion... of provider claims training to medical providers and the community. Responsibilities: Coordinates with Claims Resolution...
Overview: Under direction from the Director of Utilization Management, manages and provides direction to the Health..., Claims, and Provider Relations departments to identify, track, and monitor quality of care issues and trends. Responsible...
with all other departments to resolve claims, UM, QI, and member issues as necessary. Reports any issues with regulatory compliance to Director...Overview: Under direction from the Director of Care Coordination, manages and provides direction to the Care...
services. Responsibilities: Conducts retrospective claims review, either in the aggregate or on an individual basis. Provides... manager, director or Chief Medical Officer as appropriate. SECONDARY DUTIES AND RESPONSIBILITIES Participates in special...
services. Responsibilities: Conducts retrospective claims review, either in the aggregate or on an individual basis. Provides.../authorizations for recommended treatment. Refers cases that do not meet criteria on to the PHC HS department manager, director...
services. Responsibilities: Conducts retrospective claims review, either in the aggregate or on an individual basis. Provides... manager, director or Chief Medical Officer as appropriate. SECONDARY DUTIES AND RESPONSIBILITIES Participates in special...