At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees. This position can be performed remotely for candidates who reside in ND, MN, WI, MI, RI, OH, NC, MS, TX, AZ,

This role reviews medical paid claims against provider contracts and policies to ensure medical payments have been processed accurately. The incumbent will employ data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments. JOB ROLES AND RESPONSIBILITIES 1. Achieve measured production, quality, an

Receives assigned claims (which can be complex in nature), verifies coverage and determines course of action. Processes claims which includes the following activities set up file in MCS, establish initial reserves, conduct claim investigation, analyze investigational data, use effective medical cost containment strategies, settle non litigated claims, process expenses/los

The major responsibilities for the Risk Adjustment ACO Operations Performance Manager role include, but not limited to these items. Evaluate risk adjustment performance for multiple ACO clinical partners and identify opportunities and risk areas Cultivate effective partnerships in a matrix environment of coding educators, clinical, and market operations Implement risk adj

(Primary function) The Principal Biostatistician is responsible for providing statistical support for drug development programs in all phases of development. Essential Functions of the Job (Key responsibilities) Interact with members of the multidisciplinary project teams to establish project timelines. Provide statistical input to study protocols. Write statistical analys

Highest level individual contributor directly responsible for inventory of complex, severity Financial Institutions and Management Liability claims. Excels in a best practices claim environment, thoroughly documenting the claim process. Responsible for the timely evaluation, reserving and disposition of assigned claims Documents coverage, investigation, damages, reserve r

Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) Alert Supervisor and Special Investigations Unit to potentially suspect claims Ensure timely denial or payment of benefits in accordance with jurisdictio

Support leadership in the execution and enhancement of second line of defense Enterprise and Operational Risk Programs, including Controls Testing and Issue Management. Leading a team of Senior Analysts / Analysts within the 2LOD by providing guidance and oversight. Champion a strong risk culture for the company via elevating the risk knowledge base of associates and lead

At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees. Location Requirement This position is required to live in or relocate to either the Oregon or Washington area

The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Claims Settlement Specialist will be responsible for handling provider telephone calls regarding the payment amount paid to a provider by a payor based on Zelis data points. During this call, the Claims Settlement Specialist must understand (1) the procedures bi

Highest level individual contributor directly reviewing claims to determine nature of loss, coverage provided, and scope of claim Excels in a best practices claim environment, thoroughly documenting the claim process Responsible for the timely evaluation, reserving and disposition of assigned claims Documents coverage, investigation, damages, reserve rationale, negotiatio

Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature. Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable). Alert Supervisor and Special Investigations Unit to potentially suspect claims. Ensure timely denial or payment of benefits in accordance with jurisdic

Conduct on site inspections and assessments of property damages for both residential and commercial claims Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions

Conduct on site inspections and assessments of property damages for both residential and commercial claims Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions

Conduct on site inspections and assessments of property damages for both residential and commercial claims Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions