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Online Resumes with "Adjudication"
Claims Examiner - 0 Years of Experience
HAVING 9 years of experience in Insurance Industry actively involved in healthcare insurance and data conversion, development and implementation of supply chain solutions and data analysis with profound experience in automotive and Auto industries. * A highly motivated analyst with vast experience in interpreting, analyzing and reconciliation of data obtained from a variety of sources skills involve development and enhance...
Tags for this Online Resume: Health Insurance, Insurance, Insurance Claims, Data Modeling, Data Queries, Microsoft Excel, Modeling Experience, Quality, Quality Assurance, Customer Service
Federal Government - 20 Years of Experience - Near 20657
Defense Security Services (DSS) Personnel Security * Defense Security Services (DSS) JCAVS User Level 2 - 6 * DISS * JPAS * e-Qip * Defense Security Services (DSS )DOD HSPD-12 CAC Credentialing * Defense Security Services (DSS) Suitability Adjudications * Defense Security Services (DSS) JCAVS User Level 7&8 * Defense Security Services (DSS) JCAVS User Level 10 * Defense Security Services (DSS) Revised Federal Investigative...
Tags for this Online Resume: Microsoft, Microsoft Outlook, Microsoft Windows, Security, Typing, Typing Skills, Complaints, D.O.D., Defense, DSS
Physician, Consultation, Henry Ford Health system, médico-légal, OSHA, Chrysler, Beaumont Hospitals ,Workers’ Compensation, Disability évaluation,Veterans s
To use my medical knowledge base to consult a variety of entities including Legal entities, insurers, heavy industry, lighter supply providers. Act as liaison to Corporate personnel, Create presentations regarding ongoing project progress.
Ideal Companies: Ford Motor Company, Fiat Chrysler, General Motors co, Compuware, Quicken Loans, Law Firm
Tags for this Online Resume: Physician consultant, Occupational Medicine, OSHA, Executive Consultant, Medicolegal, Public Health, Epidemiology
Health Technologist - 18 Years of Experience - Near 07079
Experienced results-driven professional with strong leadership and relationship-building skills. Accomplished program manager and application architect with extensive experience in front office and back office operations due to extended exposure to SDLC program delivery in the Fortune 100 business sector.
Ideal Companies: CVS Caremark, Aetna, OptumRx, United Health Group, Humana Pharmacy Solutions, Envolve, Centene, Envision Rx, Anthem, Ingenio, WellCare, Tufts Health Plan, Harvard Pilgrim Healthcare, Healthfirst, McKesson, Amerisource Bergen
Tags for this Online Resume: Acquisitions, Annuity, Architect, Back Office, Compaq, Data Conversion, Data Warehouse, e-Commerce, Financial, Financial Services, PBM, Government Programs, HIPPA Compliant, Operations, Business Process Management, Business Systems Analysis, Shared Services, Lean Six Sigma, Scrum Master, MS Project, MS SharePoint, MS PowerPoint, MS Excel, MS Visio, Relational Database Management, Business Process Modeling Notation, MEGA, Agile Project Management, Waterfall Project Management, Medicare, Health Care Reform, Process Improvement, Formulary, Claims Adjudication, Utilization Management, Business Requirements, Strategy, Salesforce, CRM, EPMO, CMMI, Veeva, Data Science, Data Lake, Business Cases, Procurement, Oracle, Data Governance, Managed Markets, Supply Chain, ROI, Compliance, Vendor Management, Metrics, Reporting, Dashboarding, SDLC, KPI, COE, Trend Analysis, Executive Reporting, Trainer, Remediation, Business Owner, Consulting Services, Affordable Care Act (ACA), Agile Methodology, Applications Architecture, Applications Delivery, Benefits Strategy, Big Data, Budgeting, Business Process Change Management, Business Process Design, Business Processes Improvements, Business Process Flows, Business Process Management Bpm Software, Business Process Mapping, Business Process Modeling Notation (BPMN), Business Process Strategy, Business Process Transformations, Business Systems Consulting, Business Systems Design, Business Systems Implementation, business use case, Capability and Maturity Integration (CMMI) Requirement Management and Requirement Development Training Certification, Capability Maturity Model Integration (CMMI) Assessments, Center of Excellence, Claims Processing, Client Presentations, Client-Server, Collaborative Innovation, Continuous Process Improvement Initiatives, Cross Trainers, Customer Experiences, Customer Relationship Management (CRM), Data Definition Language (DDL), Data Warehousing Systems, DB2, Drug Information, Drug Utilization Reviews, Enterprise Solutions Architecture, Executive Presentations, Gaps Analysis, Government Affairs, HIPAA Compliance, HIPAA Guidelines, HIPPA Regulations, Information Systems Analysis, Internal Consulting, IT Systems Analysis, Key Performance Indicators (KPIs), Leadership, Leadership Mentoring, Mainframes, Management Consulting, Management Dashboards, Matrix Management, Medicare Claims, Medicare Part D, Medicare Prescription Drug Plans, Medication Therapy Management, Mentoring Programs, Microsoft Access, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft SharePoint, Microsoft SQL Server, Microsoft Visio, Microsoft Word, multi-tiered communication, Needs Assessment, New Product Introduction (NPI), Object-Relational Database, Object-Relational Databases (ORD), People Leadership, Performance Management Reporting, Performance Metrics, Pharmacy Benefits Management (PBM), Pivot Tables, Portfolio Management, Predictive Analytics, Prescriber, Prescription Drugs, Process Improvement Management, Process Reengineering, Procurement Operations, Project Management Life Cycle, Relational Database Management System (RDBMS), Requirements Traceability Matrix (RTM), Return on Investment (ROI), Scrum Methodology, Solution Architecture, SQL Relational Databases, Strategy Creation, Structured Query Language (SQL), Sybase, Systems Development Life Cycle (SDLC), Technical Project Management, Therapeutics Committee, Training the Trainer, Unified Modeling Language (UML), Use Cases, Waterfall Model, Web Based Services, Writing User Stories
Civil Service - 17 Years Experience - Near 85712
Adjudicating Criminal/Civil Hearings * Policy Development * Strategic Planning and specializing in alcohol counseling to success in life.
Ideal Companies: Nike, Climber.com. Raytheon, Booze-Allen, Boeing, General Dynamics, Caterpillar.
Tags for this Online Resume: Management, Corrective Actions, Quality, Quality Assurance, First Aid, Medical, Medical Terminology, Training, Strategic Planning, Curriculum Development
Legal Assistant - 20 Years of Experience - Near 02148
Ideal Companies: Tesla
Tags for this Online Resume: Services, Automation, Documentation, Integrate, Microsoft Word, Word Processing, Benefits, National Security, Security, Fraud
Adjudicator - 20 Years of Experience - Near 19153
Adjudicator
Not Listed - 0 Years of Experience
Business Analyst with more than seven years of experience planning, designing, training, implementing new software systems, writing business rules, documentation, and meeting with clients and internal personnel. Subject Matter Expert in Healthcare and EDI Solutions software. Possesses strong product and technical knowledge, communication skills, and organizational skills. Demonstrated ability to work both independently, re...
Tags for this Online Resume: Managed Care, Root Cause Analysis, IBM MQSeries, Business Analysis, Business Analyst, Health Insurance Portability And Accountability Act, Jad, SCRUM, Scrum Agile Methodology, Agile
"Corporate in-house counsel", "General Counsel", "Head of Legal", "Assoicate General Counsel"
I desire to be the head of legal for a company or a region.
Intelligence Officer
Tags for this Online Resume: Security, Intel, Planning, Training, Oracle Parallel Server, Aerospace, Artificial Intelligence, Certified Ethical Hacker, Cyber, Cyber Security
CIO / CTO / VP / COO / Director IT
Improve the US Healthcare System with smart innovation leveraging senior executive experience and my most recent hands-on healthcare IT role to contribute to the success of healthcare focused organization.
Ideal Companies: Healthcare Systems, Healthcare Service Providers, Software Development Companies, Pharmaceutical Manufacturers, Equipment Manufacturers
Tags for this Online Resume: Management, Health Care Industry, Nursing, Applications, Documentation, Home Health, Oncology, Security, Surgery, VITAL SIGNS, Chief Information Officer, Healthcare, Acute Care, Connected Devices, IT Security, Certified Heatlhcare CIO, Ambulatory Care, Post-Acute Care, Pharmaceutial, Genomics, Software Development
