3 claims adjudicator jobs found in Remote

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!  We promise to do what’s right, always. Position Summary: The Director, Benefit Design & Requirements (PBM) will be responsible for building and leading this function by establishing the strategic direction, operating model, and standards from the ground up. This role will initially operate as a hands-on leader while building the foundation for a scalable team and capability. As the function matures, the Director will hire, develop, and lead a team of analysts responsible for...

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!  We promise to do what’s right, always. Position Summary: The Manager, Benefit Design & Requirements (PBM) will be the founding individual contributor of this function, establishing the processes, standards, and institutional knowledge from the ground up. As the function matures, this Manager will have the opportunity to scale the team, hiring and developing analysts beneath them who will carry out the work they defined. In the near term, this person serves as AffirmedRx’s resident...

SISCO, our medical claims TPA, is looking for an experienced sales professional to launch their suite of services into new markets. Through SISCO, your broker-partners can leverage the strength of national carriers coupled with the oversight of an independent TPA. Why SISCO? “Privately Owned” does not mean private equity - Our family of companies has a history in insurance services that spans over 130 years and is characterized by organic growth with zero debt.  Professional Staff – Imagine working with a team that includes ERISA attorneys, MDs, PharmDs, RNs and Health Coaches; where member service is delivered by licensed agents and the average tenure of the Account Management team is 8+ years. True Integration – SISCO’s “One Roof” service model includes expert claim adjudication for both self-funded medical and insured ancillary benefits. Optional services include a suite of advocacy and population health...