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Jobs near Pittsburgh, PA in Management & Business
This Career Fair is a great opportunity to meet with MULTIPLE decision makers Hiring sales professionals across many industries. We understand you're tired of not knowing what to expect or who is actually looking at your resume', that's why each hiring manager gives a 2...
Participate in the analysis of data and business processes, production support activities, routine table maintenance, and interfaces to support the Health Plan Operations area(s) taking into consideration impacts to the business environment. Utilize project management...
This position is responsible for the following: * This position will aide in the development and maintenance of the network strategies for the Workers' Compensation product. * The incumbent will analyze and review provider data and work to resolve issues with internal and...
This position is responsible for the following: * Lead a team of application developers to design, develop and implement analytic and reporting applications for end users, using Base SAS and SAS BI tools, as well as other tools. * Collaborate closely with customers in all...
This position is responsible for the screening, evaluating, on-line data entry and edit correction of claims for services under the Medicare Part B Program. Dependent upon the section, incumbents may be responsible for posting responses to claims that have been suspended...
The Project Coordinator will support Medical Mall Operations for initiatives involving construction and start-up operations over a multi-year span. The Project Coordinator is responsible for the following: * Coordinating, supporting and facilitating projects as a subject...
Provide visibility to the Command Center Manager and senior management as requested that work inventories and performance is managed across all operational tiers including but not limited to Claims, Adjustments, Membership and Billing, Customer Service, Medical Management...
This position is responsible for the following: * Lead and mentor application staff in the development and/or support of systems applications, typically in support of simple to moderate business functional areas. * Work with staff and management to provide simple to complex...
In a multi-state, multi-line of business environment, this position is responsible for the following: * Reviewing, verifying and entering provider practitioner files from delegated credentialing entities into the CACTUS credentialing system which serves as the source for...
The Continuous Process Improvement Consultant I is responsible for increasing Highmark Health Plan Operations'(HPO) value to its customers by identifying, designing, developing and implementing improvements to critical business operations. This is achieved by: * Utilizing...
This position is responsible for the following: * Anticipate the need for, and develop sound, profitable products that win market share in the emerging world of retail based individual products. * Develop, maintain and adjust group products and individual under-65 products...
* Complete timely review to determine medically necessary services at the appropriate level of care, utilizing standard criteria and clinical judgment, based on the benefits for each line of business and Gateway Health Plan policies and procedures. * Ensure clinical review...
This position is responsible for: *Planning and managing all activities within an assigned business unit/area. This includes multiple application development, maintenance, and enhancement projects utilizing various new computing architectures (e.g., client/server, intranet,...
SUMMARY OF JOB RESPONSIBILITIES: * Providing technical expertise: o Within an assigned systems unit/area, usually as a member of a project team or production support team, in the design and development of small business applications. o On projects or systems issues of a...
This position is responsible for the following: * Understand all aspects of a particular Highmark application and work with the application development team to understand the business requirements in order to develop and implement an application architecture that adheres to...
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