Title: Grievance & Appeals Nurse (RN) Job Responsibilities: The Grievance & Appeals Nurse (RN) is responsible for managing and processing medical necessity appeals requests from members and providers. Key responsibilities include: - Supporting legal, management, and executive leadership by overseeing State Fair Hearing...
by managing State Fair Hearing and External Medical Review requests. - Act as a resource for clinical and non-clinical teams by managing and conducting thorough investigations and reviews of medical necessity appeals in preparation for litigation. - Document and log......
Title: Contracting Counsel Senior Manager Job Responsibilities: - Lead,... structure, negotiate, and close the company's largest and most complex client transactions to be most advantageous from a legal and business perspective. - Oversee, counsel, guide, train, and support junior Contracting...
Title: Contracting Counsel Senior Manager Job Responsibilities: - Lead, structure, draft,... and negotiate complex client transactions in a fast-paced corporate environment. This includes agreements such as master services agreements, outsourcing agreements, statements of work, service level agreements, licensing agreements, SaaS agreements, data...
at the company. This role involves leading and managing in-house legal staff in key areas such as labor and employment, administrative law, contracts, real estate, litigation, claims, and workers' compensation.... The responsibilities include overseeing all legal matters for the...
Title: Senior Counsel - Financial Risk Solutions Legal Job Responsibilities: - Advise on legal and regulatory issues related to financial lines insurance products and related transactions. - Provide counsel on insurance transactions, including drafting and negotiating insurance policies, collateral agreements, term sheets, NDAs,...
Title: Senior Counsel - Credit & Political Risk Job Responsibilities: The role of Senior Counsel - Credit & Political Risk involves offering expert legal advice and support to the Management Liability & Specialty (MLS) Legal team within the Excess, Surplus & Specialty...
Title: Investigator Senior - Pharmacy Job Responsibilities: The Investigator Senior - Pharmacy is responsible for independently identifying, investigating, and developing complex healthcare cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims. Key responsibilities include: - Conducting...