NewThird Party Analyst Care New England Health SystemThird Party AnalystWarwick, RICare New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation's top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.
NewClaim Benefit Specialist CVS Health CorpClaim Benefit SpecialistRI$17–$28.46 / hourAnalyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
Director Payment Integrity Blue Cross & Blue Shield of Rhode IslandDirector Payment IntegrityProvidence, Rhode IslandTo further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia.
Mgr, Business Consultant CVS Health CorpMgr, Business ConsultantRI$60,300–$132,600 / yearThe Manager will be responsible for ensuring the accuracy, completeness, and timeliness of encounter data submissions while partnering closely with internal business and technical teams, as well as external vendors, to meet regulatory and operational requirements across multiple states. As the Dual Special Needs Plan (DSNP) business continues to expand, we are seeking an experienced Manager, Encounter Data & State Submission Operations to lead the end-to-end management of encounter and claims data submissions to state agencies.
Supervisor of TPC and CCBHC Revenue Cycle Care New England Health SystemSupervisor of TPC and CCBHC Revenue CycleWarwick, Rhode IslandFull timeJob Summary: The Supervisor of TPC and CCBHC Revenue Cycle is an operational leader responsible for supporting the day-to-day revenue cycle functions for The Providence Center (TPC) and Certified Community Behavioral Health Clinic (CCBHC) services. This role focuses on ensuring timely billing, accurate follow-up, and resolution of accounts receivable, while supporting a high-touch, service-oriented model that requires significant manual intervention.
Content Claims Specialist - Field - Level I Crawford & CoContent Claims Specialist - Field - Level IProvidence, RIRemoteTo determine the actual offer, Crawford considers a wide range of factors including the candidate's previous experience and education, market rates, minimum pay requirements for the applicable jurisdiction, business segment, supply/demand, and scheduled hours. Communicate with adjusters/policyholders and industry vendors to explain their roles as Content Claims Specialists and their respective roles/contributions in the claims handling process.
Senior Director, Customer Business Development CVS Revlon IncSenior Director, Customer Business Development CVSProvidence, RIRemote$170,000–$210,000 / yearDirector is expected to challenge the status quo, identify new go-to-market opportunities, influence across merchandising, marketing, supply chain, store operations, finance, and digital/omnichannel teams, and mobilize internal cross-functional partners to deliver business results with excellence. Director, Sales is responsible for developing, executing, and fostering a collaborative business partnership between Revlon brands and CVS with accountability for delivering volume, share, profitability, and customer category growth objectives.
Deputy Personnel Administrator State of Rhode IslandDeputy Personnel AdministratorProvidence, RI$133,541–$152,065 / yearThe Deputy Personnel Administrator provides leadership and direction to professional Benefits Unit staff and works collaboratively with executive leadership, agency human resources teams, labor relations, union representatives, finance, procurement, legal counsel, actuaries, brokers/consultants, and external vendors to ensure compliant, equitable, fiscally responsible, and customer-focused delivery of benefits services statewide. REQUIRED QUALIFICATIONS FOR APPOINTMENT: KNOWLEDGES, SKILLS AND CAPACITIES: A thorough knowledge of the principles, practices and techniques of modern public personnel administration; a thorough knowledge of state government, and of the organizational structure and functions of its departments and agencies; a thorough knowledge of the principles, practices and techniques of personnel psychology, including position classification, employee selection and evaluation, organizational behavior, test development and construction; a thorough knowledge of any directly assigned program area, e.g.
Compliance and Risk Officer PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THECompliance and Risk OfficerProvidence, RIThe Compliance and Risk Officer is responsible for the development, implementation, oversight, and continuous improvement of Providence Community Health Centers' Corporate Compliance Program, Enterprise Risk Management Program, Patient Safety Program, and Health Insurance Portability and Accountability Act (HIPAA) Privacy Program. The Compliance and Risk Officer serves as the organization's designated Compliance Officer and HIPAA Privacy Officer and provides support in identifying, assessing, mitigating, and monitoring organizational risk while ensuring compliance with applicable federal and state laws, regulations, contractual requirements, and organizational policies.
Claims Advocate Specialist First American Financial CorpClaims Advocate SpecialistProvidence, RIFirst American reasonably believes that a criminal history may have a direct, adverse and negative relationship with the following material job duties for this position potentially resulting in the withdrawal of the conditional offer of employment: handling of confidential, proprietary or trade secret information belonging to First American or its customers, administrating or facilitating financial transactions, and the ability to meet customer-imposed criminal history requirements. Our inclusive, people-first culture has earned our company numerous accolades, including being named to the Fortune 100 Best Companies to Work For list for eleven consecutive years.
Senior Claim Benefit Specialist - Remote CVS Health CorpSenior Claim Benefit Specialist - RemoteRIRemote$18.50–$42.35 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication.
Claims Negotiation Manager CVS Health CorpClaims Negotiation ManagerRI$66,330–$145,860 / yearDemonstrated expertise in the No Surprises Act (NSA), out-of-network reimbursement methodologies, provider billing practices, and healthcare claims adjudication, with the ability to interpret complex regulations, evaluate claim and reimbursement disputes, guide negotiation strategies, ensure compliance, and drive favorable financial and operational outcomes. Lead daily negotiation operations while partnering closely with Product, Operations, Compliance, Analytics, and Client teams to enhance negotiation strategies, support product development, drive operational excellence, and ensure compliance with federal and state regulations.
Senior Provider Experience Program Manager - Healthcare Claims CVS Health CorpSenior Provider Experience Program Manager - Healthcare ClaimsRI$106,605–$284,280 / yearWhat you will do: Lead enterprise delivery of multiple, highly complex business process and technology initiatives aligned to the Provider Experience / Provider NPS program, supporting all lines of business. Drive Agile delivery of Provider Experience / Provider NPS initiatives, supporting business process and technology improvements across multiple lines of business.
Claims Unit Manager - Property AAAClaims Unit Manager - PropertyLincoln, Rhode Island$120,500–$160,800 / yearThe primary functions include effective loss and expense management, employee development and succession planning, training, staffing, performance measurements and continuous improvement. With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
Senior Analyst Claim Reporting and Special Services Qureos IncSenior Analyst Claim Reporting and Special ServicesWoonsocket$46,988–$112,200 / yearPosition Summary : We are looking for a highly motivated candidate who can effectively and accurately oversee and coordinate rework projects, work closely with other members of the Commercial Services Operations team providing project management, root cause analysis and precise resolution of affected claims. The candidate will serve as a Project Lead for rework projects/issues for a specific network or large-scale rework projects generated as a result of Plan Sponsor issues, release fallout and/or legal/regulatory/compliance concerns.
Liability Litigation Claims Examiner | Litigation, Premise, Auto, BI & Product Claims Experience | Remote Sedgwick Claims Management Services, Inc.Liability Litigation Claims Examiner | Litigation, Premise, Auto, BI & Product Claims Experience | RemoteRIRemote$63,404–$88,765 / yearTo analyze GL Litigated, Premise, Auto, Bodily Injury & Product claims on behalf of our valued dedicated client to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
NewSenior Counsel JobotSenior CounselJohnston, RI$135,000–$250,000 / yearInformation collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. By combining centralized resources, consistent processes, and deep industry expertise, we help our partners operate efficiently while responding to the unique needs of the markets and communities they serve.