Top 99 Claims manager Jobs in Idaho

Manager, Payment Integrity-COB/TPL /Subrogation
Centene —Idaho
- $87,700 - $157,800 a year
- Full-time
- Remote
- Management
- Mid-level
- Supervising experience
- Paid holidays
- Health insurance
1d
Manager Quality
West Valley Medical Center —Caldwell, ID
- $96,636.80 - $144,955.20 a year
- Full-time
- 5 years
- Experience equivalent to degree accepted
- Senior level
- Employee stock purchase plan
- Disability insurance
Quick Apply
10d
Lead SIU Investigator
Centene —Idaho
- $70,100 - $126,200 a year
- Full-time
- Remote
- Master's degree
- High school diploma or GED
- Mentoring
- Paid holidays
- Health insurance
Manager Clinical Pharmacy Quality and Affordability Programs
Cambia Health Solutions —Boise, ID
- $140,000 - $228,000 a year
- Full-time
- Hybrid work
- Background check
- Writing skills
- HIPAA
- Health savings account
- Paid holidays
Sr. Manager, Pricing - Pharmacy Appeals
CVS Health —Idaho
- $67,900 - $182,549 a year
- Full-time
- Remote
- 7 years
- Microsoft Access
- Office
- Health insurance
- Dental insurance
Case Manager, Registered Nurse
CVS Health —Idaho
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
Manager In Training Meat Department
WinCo Foods —Boise, ID
- Mid-level
- Windows
- Forklift
- Health insurance
- Employee stock ownership plan
Quick Apply
9d
Managed Care Contracting Manager
Pennant Services, Inc. —Eagle, ID
- $95,000 - $105,000 a year
- Full-time
- Microsoft Word
- Microsoft Outlook
- 5 years
Quick Apply
9d
Senior Manager, Medical Economics
CVS Health —Boise, ID
- $67,900 - $199,144 a year
- Full-time
- 5 years
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
Resolutions Manager
Lookout Credit Union —Pocatello, ID
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Sales
Manager, Actuarial Services
Centene —Idaho
- $134,600 - $249,000 a year
- Full-time
- Remote
- 5 years
- Research
- SQL
- Paid holidays
- Health insurance
University Risk Manager
University of Idaho —Moscow, ID
- $110,000 a year
- Weekends as needed
- Background check
- Management
- Mid-level
Account Manager- Healthcare Mkts (Pharmacy Benefit Management)
RxBenefits, Inc. —Idaho
- $56,800 - $71,000 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
8d
Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics
CVS Health —Idaho
- $100,000 - $231,540 a year
- Full-time
- Remote
- Computer Science
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
14d
Safety Technician Lead
Gallagher Bassett —Meridian, ID
- Full-time
- Management
- Construction site
- Senior level
- Paid parental leave
- Health savings account
Lead Director, Healthcare Medicaid Risk Adjustment Analytics
CVS Health —Idaho
- $100,000 - $231,540 a year
- Full-time
- Remote
- 3 years
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
Lead Director, Risk Adjustment Performance Reporting and Insights
CVS Health —Idaho
- $100,000 - $231,540 a year
- Full-time
- Remote
- Computer Science
- Bachelor's degree
- Mentoring
- Health insurance
- Dental insurance
14d
Human Resources Manager
Bob Evans Foods —Rigby, ID
- Full-time
- Microsoft Word
- Bachelor of Science
- 3 years
Project Procurement Manager
Kiewit Corporation —Idaho Falls, ID
- $135,000 - $170,000 a year
- Overtime
- Microsoft Excel
- Construction site
- 5 years
- Relocation assistance
- Health insurance
Senior Manager, Staff Counsel - Western Region
GEICO —Boise, ID
- $148,625 - $231,650 a year
- Full-time
- Hybrid work
- Writing skills
- Travel
- Conflict management

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claims manager jobs near idaho

Manager, Payment Integrity-COB/TPL /Subrogation

Centene -
Idaho

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Job Details

Full-time
$87,700 - $157,800 a year
1 day ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Medical terminology

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:
Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes

Oversee Coordination of Benefits (COB), Third Party Liability (TPL), and Subrogation recovery activities, including identification of other coverage, validation of recovery opportunities, coordination with internal operational teams, and timely resolution of provider, member, and carrier-related issues
Monitor internal and vendor and platform performance for COB/TPL/Subrogation programs, including savings, inventory, cycle times, quality outcomes, and adherence to recovery policies and regulatory requirements
Monitor business processes and systems to assure integrity and compliance in billing and claims payment
Lead teams of analysts to appropriately investigate all possible fraud, waste and abuse referrals
Develop customized fraud plans to meet contract and federal requirements
Develop educational materials to identify/validate waste activities as requested by the health plan and on an ad-hoc basis
Respond to RFP request and implement new policies per contractual obligation
Attend state/federal meetings as required by specific contracts
Prepare/present the FWA program to state/federal personnel upon request, specifically during readiness reviews, and immediately following the go live or upon state agency personnel changes
Review post-payment cases with appropriate parties to obtain refund
Prepare and distribute monthly and quarterly saving reports
Performs other duties as assigned
Complies with all policies and standards

Education/Experience:
Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience. 4+ years of medical claim investigation, compliance or fraud and abuse experience. Thorough knowledge of medical terminology required. Experience with Coordination of Benefits (COB), Third Party Liability (TPL), Subrogation, or healthcare recovery operations preferred. Previous experience in managed care environment and as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred.

License/Certification: Medical records or coding license preferred.

Pay Range: $87,700.00 - $157,800.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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Refine Your Search

claims manager jobs in idaho

Manager, Payment Integrity-COB/TPL /Subrogation

Manager Quality

Lead SIU Investigator

Manager Clinical Pharmacy Quality and Affordability Programs

Sr. Manager, Pricing - Pharmacy Appeals

Case Manager, Registered Nurse

Manager In Training Meat Department

Managed Care Contracting Manager

Senior Manager, Medical Economics

Resolutions Manager

Manager, Actuarial Services

University Risk Manager

Account Manager- Healthcare Mkts (Pharmacy Benefit Management)

Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics

Safety Technician Lead

Lead Director, Healthcare Medicaid Risk Adjustment Analytics

Lead Director, Risk Adjustment Performance Reporting and Insights

Human Resources Manager

Project Procurement Manager

Senior Manager, Staff Counsel - Western Region

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