2 litigation consultant 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...

To provide ultimate claim service for insurance claim matters presented by clients of Risk Strategies Inc., and affiliates, in accordance with objectives and procedures outlined by management. Your Impact Receive loss reports from Healthcare Clients and confirm that the claims are filed under the appropriate policy(ies) Research policy terms and stipulations to determine coverage applicability and advocate for maximum recovery. Strong understanding of all lines of insurance policies, coverage, and relevant regulations. Educate and address questions from Clients regarding claim reporting requirements Advocate for the client, maintaining an active diary, transmittal of documentation, follow up calls, and emails to the client and carrier Oversee the claims at the carriers to ensure timely investigation, liability determination, litigation and fair resolutions.  Evaluate complex, high-exposure claims and interpret policy wording. Ability to work with demanding stakeholders,...