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The Senior Claims Manager will oversee and ensure the efficiency and accuracy of healthcare claims operations. This position oversees the claims inventory by setting, evaluating, and monitoring the claims inventory and examiner production metrics and is responsible for timely and precise benefit determinations for claims, while upholding exceptional service standards for
Posted 3 days ago
The Sr. Manager of Provider Network leads and manages provider contracting and network developments consistent with the strategic goals of Prominence Health Plan & is responsible for ensuring the satisfaction of Plan Participating Providers by maintaining excellent relationships and facilitating growth and retention. This position is responsible for the development and ma
Posted 3 days ago
The Special Investigations Unit is responsible for investigating and resolving high complexity healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. This position researches, gathers, and analyzes claims data, medical records, corporate policy, state/federal policy, and practice standards to identify trends, patterns, aberrancies, and o
Posted 12 days ago
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