Top 161 Claims manager Jobs in Woonsocket, Ri

Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule
Fallon Health —Worcester, MA
- Full-time
- Hybrid work
- Clean driving record
- Research
- Mid-level
Commercial Lines Account Manager
BayCoast Insurance —Swansea, MA
- $61,316 - $98,110 a year
- Full-time
- Spanish
- Mid-level
- In-person
- Disability insurance
- Health insurance
Quick Apply
5d
Assistant Manager - Final Mile Delivery
Pillar Logistics —Westwood, MA
- $55,000 - $65,000 a year
- Full-time
- Mid-level
- Office
- Mentoring
Quick Apply
Supervisor, Casualty Claims (Hybrid, Webster)
MAPFRE —Webster, MA
- $77,700 - $111,900 a year
- 7 years
- Computer literacy
- Math
- Profit sharing
- Health savings account
Assistant Manager
Rocky's Ace Hardware —Canton, MA
- $20 - $24 an hour
- Full-time
- Merchandising
- Mid-level
- Retail management
HVAC Service Manager
Endless Energy —Marlborough, MA
- $90,000 - $120,000 a year
- Full-time
- Background check
- Clean driving record
- 5 years
- Fuel card
- Health insurance
Quick Apply
Manufacturing Engineering Supervisor - Laser Syste
The Judge Group —Oxford, MA
- $70,000 - $95,000 a year
- Full-time
- Mid-level
- 3 years
- In-person
Quick Apply
6d
Business Manager
Blue Hills Ski Area —Canton, MA
- $28 - $35 an hour
- Part-time
- Mid-level
- Office
- 3 years
Quick Apply
Auto Service Manager/Advisor - 5+ Yrs Exp - $80k to $110k/year! SALARY PLUS BONUS!
Shannon Motors —Johnston, RI
- $80,000 - $110,000 a year
- Full-time
- ASE Certification
- Dealership
- 5 years
- Health insurance
- Dental insurance
Quick Apply
18h
Manufacturing Engineering Supervisor - Laser Systems Repair
IPG Photonics —Oxford, MA
- $70,550 - $97,359 a year
- Mid-level
- Office
- Travel
- Health savings account
- AD&D insurance
Quick Apply
Manufacturing Engineering Supervisor
Ardent Staffing Solutions —Oxford, MA
- $70,550 - $97,359 a year
- Full-time
- Mid-level
- Office
- 3 years
- Health savings account
- AD&D insurance
Quick Apply
6d
Client Service Manager
Gallagher —Westborough, MA
- $60,500 - $101,000 a year
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
- Paid parental leave
- Health savings account
Client Service Manager
Gallagher —Westborough, MA
- $63,500 - $106,500 a year
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
- Paid parental leave
- Health savings account
Senior Account Manager (Fully Remote)
Insurance Office of America, Inc. —Woonsocket, RI
- $80,000 - $100,000 a year
- Full-time
- Microsoft Outlook
- 5 years
- Research
- Paid holidays
- Health insurance
Quick Apply
Operational Risk Manager
Securitas Security Services —Providence, RI
- Full-time
- Hybrid work
- Office
- Bachelor's degree
- Continuous improvement
- Health savings account
- Paid holidays
Location Manager
Zūm —Johnston, RI
- $100,000 - $115,000 a year
- Full-time
- Google Workspace
- Inventory management
- 5 years
Quick Apply
Safety Supervisor
Zūm —Johnston, RI
- $80,000 - $130,000 a year
- Full-time
- School experience
- Microsoft Outlook
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Contract Manager, Managed Care Contracting
UMass Memorial Health —Worcester, MA
- $83,116.80 - $149,593.60 a year
- 8 hour shift
- Hybrid work
- Bachelor of Science
- Mid-level
- Office
Lead Total Cost of Care Implementation Manager
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $102,300 - $163,700 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Mid-level
- Office
- Loan repayment program
- Dental insurance
Purchasing Manager $85K-$100K
Omni Control Technology —Whitinsville, MA
- $85,000 - $100,000 a year
- ERP systems
- Research
- Mid-level

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Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule

Fallon Health -
Worcester, MA

Apply Now

Job Details

Full-time

Qualifications

Managed care organization experience
Presentations for conferences or internal meetings
Employee relationship building
Driver's License
Computer skills
Stakeholder relationship building

Full Job Description

Overview:

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of purpose:

Responsible for the analysis, negotiation/renegotiation, implementation, readjustment, evaluation, and continuous improvement of all functions of provider contracting. Manages financial and operational issues related to contractual provider arrangements. Responds to both internal and external customers regarding provider contractual arrangements, both for contract implementation and ongoing operations.

Responsibilities:

Primary Job Responsibilities:

Negotiates, develops and designs contractual provider (Hospital and physician) arrangements including language and pricing methodologies.
Evaluates contractual payment methodologies in order to determine financial risk to insurer and provider (per diem, capitation, discount from charge, DRG, case rate, bundled payments, pay for performance programs, etc.). Ensures the design, production, and distribution of site financial, utilization and member information; ensures the production and completeness of annual site settlement reports. Interfaces between the Plan’s Finance department and individual sites for budget, financial reporting and settlement arrangements for all relevant products.
Performs quantitative analyses of various financial and clinical data in order to evaluate multiple contracting options. Reports on performance of ongoing contractual arrangements to appropriate parties.
Manages, coordinates and resolves operational issues related to specific areas of responsibility. Serves as contact person for internal departments (i.e. Claims, Finance, Care Management Services, Patient Relations, Marketing, Credentialing, Provider Relations, etc.).
Researches, analyzes and presents recommendations to Manager regarding contractual and financial decisions.
Manages provider correspondence relating to contracts and responds to requests from potential new providers for FCHP.
Maintains computerized tracking system for new and revised agreements. Coordinates and communicates contractual information to appropriate departments within FCHP.
Maintains assigned provider network; physician, hospital, ancillary, and/or carve out vendor as assigned by Director or Manager.
Prepares, updates and maintains files and database for all assigned provider contracts.
Serves as committee member in cross-functional teams as assigned by Director or Manager.
Assists in Provider Relations activities including servicing, educating and distributing information to contracted providers.
Analyzes and presents financial reports to providers. Makes recommendations to providers regarding quality and cost improvements.
Other duties as assigned.

Additional Performance Requirements:

Must be a team player with strong relationship building skills.
Must be able to prepare and conduct formal presentations to small and large audiences both internally and externally

Qualifications:

Education:

Bachelor’s degree or equivalent experience required.

Master’s degree in Business Administration, Healthcare Administration, or Public Health preferred. Previous background in nursing or any allied health field is often valuable but not required

License/Certifications

Valid Driver’s License and Clean Driving Record Required

Experience:

Minimum of three years experience in managed healthcare environment(s) with related work in provider contracting, healthcare finance, provider reporting/profiling, and/or provider relations. Experience in provider contract negotiations, including FFS, capitation models, Hospital contracts and pay for performance models is preferred. Excellent analytical, strategic thinking, and creative thinking skills are required. Superior verbal and written skills, excellent computer skills (Word, Excel, Access) are essential to this position.

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $100,00-$120.000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Refine Your Search

claims manager jobs in woonsocket, ri

Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule

Commercial Lines Account Manager

Assistant Manager - Final Mile Delivery

Supervisor, Casualty Claims (Hybrid, Webster)

Assistant Manager

HVAC Service Manager

Manufacturing Engineering Supervisor - Laser Syste

Business Manager

Auto Service Manager/Advisor - 5+ Yrs Exp - $80k to $110k/year! SALARY PLUS BONUS!

Manufacturing Engineering Supervisor - Laser Systems Repair

Manufacturing Engineering Supervisor

Client Service Manager

Client Service Manager

Senior Account Manager (Fully Remote)

Operational Risk Manager

Location Manager

Safety Supervisor

Contract Manager, Managed Care Contracting

Lead Total Cost of Care Implementation Manager

Purchasing Manager $85K-$100K

I want to receive the latest job alert for claims manager in woonsocket, ri

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