• Medi-Cal Pharmacist Claims Jobs in United States Of America

  • DXC Technologies
  • United States Of America, Usa
  • Save Job
  • 12 - 15 Years
  • Posted : above 1 month

Job Description:

The Insurance/Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare Develops and implements general insurance and health policies in accordance with state and federal laws Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions Responds to provider appeals and meets with providers to resolve problems/issues Provides directions for utilization review Approves any remedial or recoupment actions associated with escalated claims Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs


Participates, coordinates and leads in the identification, documentation, analysis and validation of advanced business processes, systems, and solution requirements
Leads the research, evaluation and design components of complex solutions to problems
Provides expertise and guidance to support requirements of large cross- functional initiatives and projects, while contributing to the development and techniques used to meet the requirements of the business unit
Develop strategies and provide leadership toward the analysis, information validation, and decision- making process in a team environment, while ensuring cross-functional requirements/needs are met
Provides leadership and facilitates process improvements that cross functional business units and ensure customer satisfaction
Managelead multiple assignments with no supervision

Education and Experience Required

Bachelors degree in healthcare or related field
Must have current certification and licensing in area of expertise May hold advanced certification in work field
Typically minimum of 12 years of relevant experience with Bachelors degree
Typically, 12 years of working experience
Must possess current certification, including necessary licenses, for the field of specialty (as required)

Knowledge and Skills

Experience with expert knowledge of commercial and government insurance programs
Extensive level of understanding and application of healthcare related technologies
Experience leading large projects, managing the implementation of a new/ expanded business process, interpreting research, and providing complex problem resolution
Demonstrated leadership ability
Ability to lead andmanage a cross-functional team in the planning, development and resolution of complex projects/issues
Excellent written, verbal, and presentation skills
Demonstrated ability to develop and present a wide variety of complex materials and communications that will be used to effectively reach both internal and external customers, and build trusting relationships through collaborative work activities
Strong proposal writing and editing skills
Proactively and accurately assesses the time and resources needed to complete an assignment
Experienced in teaching others to research and resolve customer inquiries by identifying trends and utilizing available resources
Self-motivated with excellent time management and organizational skills
Ability to work and communicate with high level executives and government officials
Must possess current certification, including necessary licenses, for the field of specialty (as required by the position)

Profile Summary:

Employment Type : Full Time
Eligibility : Any Graduate
Industry : Software Services, Internet/Dot com/ISP
Functional Area : Accounting/Tax/Company Secretary/Audit
Role : Chartered Accountant/CPA
Salary : As per Industry Standards
Deadline : 07th Jan 2020

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