85 claim director jobs found in Philadelphia, PA

JOB RESPONSIBILITIES Analyze contracts, policies, applicable law and facts/circumstances surrounding claims to determine appropriate coverage position, and to resolve claims on reasonable terms and at an appropriate value.     Responsible for conducting/managing factual claims investigation, including communications with policyholders, remediation experts, counsel and others to gather all claim facts. Negotiate cost sharing agreements with carriers/policyholders. Assign defense counsel, and manage litigation strategy and budgets.  Evaluate claims and make recommendations to management regarding claim resolution plans. Maintain physical/electronic claim file, and claim information captured in claim systems.  Respond to internal requests for information from management, reinsurers, auditors, etc. Prepare timely and accurate reports to management regarding significant claim developments. Provide the highest levels of service to Chubb business partners....

JOB RESPONSIBILITIES Analyze contracts, policies, applicable law and facts/circumstances surrounding claims to determine appropriate coverage position, and to resolve claims on reasonable terms and at an appropriate value.     Responsible for conducting/managing factual claims investigation, including communications with policyholders, remediation experts, counsel and others to gather all claim facts. Negotiate cost sharing agreements with carriers/policyholders. Assign defense counsel, and manage litigation strategy and budgets.  Evaluate claims and make recommendations to management regarding claim resolution plans. Maintain physical/electronic claim file, and claim information captured in claim systems.  Respond to internal requests for information from management, reinsurers, auditors, etc. Prepare timely and accurate reports to management regarding significant claim developments. Provide the highest levels of service to Chubb business partners....

JOB RESPONSIBILITIES Analyze contracts, policies, applicable law and facts/circumstances surrounding claims to determine appropriate coverage position, and to resolve claims on reasonable terms and at an appropriate value.     Responsible for conducting/managing factual claims investigation, including communications with policyholders, remediation experts, counsel and others to gather all claim facts. Negotiate cost sharing agreements with carriers/policyholders. Assign defense counsel, and manage litigation strategy and budgets.  Evaluate claims and make recommendations to management regarding claim resolution plans. Maintain physical/electronic claim file, and claim information captured in claim systems.  Respond to internal requests for information from management, reinsurers, auditors, etc. Prepare timely and accurate reports to management regarding significant claim developments. Provide the highest levels of service to Chubb business partners....

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) As a Community Outreach Representative (COR) you'll utilize innovative strategies and programs to ensure access to health care coverage for the underserved and impact millions of lives. You'll use your energetic, empathetic approach to marketing and add value to our team. Through community marketing and outreach efforts, you will have direct impact on membership growth and retention. You'll use your creativity, strategic lens, and outspoken attitude to be part of an elite team to rewrite the history of UnitedHealth Group. This COR...

UnitedHealth Group is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Review medical claims data for accuracy and assist with the resolution of any discrepancies Analyze medical data and interpret key drivers of healthcare trends Conduct studies on healthcare utilization and costs to identify savings opportunities Provide management with actuarially informed findings and conclusions Assist in peer review of analyses completed by actuarial analysts Mentor and supervise actuarial analysts in the technical aspects of the team's projects...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) As an Compliance Data Consultant, you’ll review data, look for patterns of potential fraud, waste and/or abuse and interact with the Special Investigations Unit (“SIU”) to complete investigations. You’ll be fully invested in the outcomes and will be helping the health system work better for everyone with the support and resources of a Fortune 5 industry leader.  You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Establish, mandate and implement standard policies, procedures and best practices regarding UnitedHealthcare Investigations’ claim...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) Optum Labs is the research and development arm of UnitedHealth Group. We're a diverse team of curious thinkers and experts in big data, artificial intelligence and machine learning, and scientific and clinical research searching for new ways to help people live healthier lives. We partner with world leaders in health care delivery, research, and technology to create disruptive solutions that serve patients, caregivers, providers, and commercial and government payers. More equitable, effective, and affordable health care -...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) Position in this function assesses and interprets customer needs and requirements. Identifies solutions to non-standard benefit and pricing requests and problems. Solves moderate to complex problems and/or conducts moderate to complex analyses. Works with minimal guidance; seeks guidance on only the most complex tasks. Translates concepts into practice. Provides explanations and information to others on difficult issues. Acts as a resource for others with less experience.   Primary Responsibilities: Maintain and perform intra-department audits Provide intra-departmental information and support on basic to difficult in-house...

If you are located within commutable distance of 2720 N Tenaya Way, Las Vegas, NV, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges. At UnitedHealthcare , we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work.SM This position will be customer service focused with a lot of member service communication and outreach. This role is responsible for reviewing appeals and requesting appropriate medical records, reviewing clinical records submitted by provider, utilize evidence-based guidelines to make decisions, summarize clinical information for write up and write denial rationales, and assist with administrative...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) In joining the Optum Advisory Services Trend Analytics Consulting team: you’ll be part of a team that is leader in health care cost analytics, with a proven track record of supporting health plans across the country though a diverse staff of Actuaries, Data/Research Analysts, and Business/Technology Consultants.  Our consulting team has continued to expand capabilities and consulting presence by identifying, developing, and executing on new and exciting business opportunities.  As a member of our high-performing team,...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) Community & State (C&S) Network Program Managers work closely with United Health Networks (UHN), C&S Healthplans, Implementation & Business Alignment (IBA), Teams within Provider Operations, and have a dotted line relationship to various IT teams as needed. C&S Network Program Managers are each assigned 3-5 active new state or product implementations at one time. Positions in this function are responsible for end-to-end project management and point person for all of  Provider Operations, coordination of cross-functional teams, & highlighting areas of risk and mitigation plans. You’ll enjoy the flexibility to...

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm) The Pharmacy Audit Rep Sr. will work on a wide range of activities to support pharmacy operations and initiatives to help meet goals and deliverables. Conducts audits of pharmacy claims in alignment with prior authorization requests and conducts audits of various pharmacy initiatives. Responsible for gathering and evaluating data from multiple sources to support ongoing pharmacy daily operations. Assist pharmacy leadership with business process and policy development of programs and productivity metrics. Assist with report development and analysis to support key initiatives and operations.  You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.  Primary Responsibilities: Supports daily operations...

If you are located within the state of California, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges. The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you'll be responsible for the implementation and day to day performance of process activities related to claims research and resolution. This includes the review of claims, contracts, and fee schedules to identify processing, procedural, systemic and billing errors. Join us and build your career with an industry leader. This is a challenging role with serious impact. You'll be providing a senior level of support to a fast paced, intense and high-volume claims operation where accuracy and quality are essential. This position is full - time (40...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) As a Senior Healthcare Economics Data Analyst in Optum’s Product Analytics organization, you will perform critical data analytics that examine the effect of Optum Health’s Care Management products on costs and utilization of the members served.  Your role will include helping source data, helping develop and maintain data marts, partnering with internal stakeholders to understand and document data requirements, and...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) As a Senior Healthcare Economics Data Analyst in Optum’s Product Analytics organization, you will perform critical data analytics that examine the effect of Social Determinants of Health on the administration and outcomes of Optum Health products.  Your role will include data analytics for product development and pilot evaluations, partnering with internal stakeholders to understand and document data requirements,...

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm) Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work. We are searching for a healthcare economics consultant to join our experienced team. This creative role offers an excellent opportunity to directly impact an innovative function and secure your future with an industry leader.  This role sits within a functional support team that works supporting strategy...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Support actuarial reports and analytics to support Part C and Part D bid development Conduct and evaluate studies on risk adjustment, utilization, and health care costs Perform mathematical analyses and actuarial modeling to provide project managers with...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.   Primary Responsibilities: Interpret and analyze claims, capitation, membership data, and recommend best approaches in support of underwriting, actuarial and utilization analyses Lead projects to completion by contributing to database creation, statistical modeling and financial reports Create and update automated processes Performs complex data validation and conceptual analyses. Analyze reporting tools utilized by the internal customer groups Serves as subject matter expert to health plans...

If you are located within Washington D.C, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges. Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing  your life's best work . SM This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 7:00pm CST. It may be necessary, given the business need, to work occasional overtime. *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Primary Responsibilities: Respond to and resolve, on the first call, customer service inquiries and issues from several sources (Provider, Member, Customer) Research complex issues using multiple UMR proprietary...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do  your life's best work.(sm) You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Design actuarial reports and analytics to support Part C and Part D bid development Conduct and evaluate studies on risk adjustment, utilization, and health care costs Perform mathematical analyses and actuarial modeling to provide clients with statistical...