Lansing, Michigan, United States · Remote OK
$107k–$179k/yr
The Clinical Pharmacist is responsible for promoting appropriate and/or efficient utilization review of prescription drug claims among BCBSM participating physicians. This position is also responsible for the education o…
Skills: Clinical Coverage Review, Drug Utilization Review, Pharmacotherapy, Medical Policy Development, Drug Formulary Management
Lansing, Michigan, United States · Remote OK
$64k–$109k/yr
SUMMARY: Claim Representative I: This is the entry level professional claim handler. Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves.…
Skills: Claim Investigation, Compensability Determination, Claim Reserves Management, Settlement Negotiation, Mentoring
Lansing, Michigan, United States · On-site
SUMMARY: Responsible for initiating, printing, and distributing general disbursements for the entire enterprise. Completes routine general ledger entries. Research and updates payee information. Supports daily cash manag…
Skills: Accounts Payable, General Ledger, Financial Reporting, Cash Management, ACH and Wire Transfers
Lansing, Michigan, United States · Remote OK
$122k–$203k/yr
SUMMARY: MO Licensed | IL Preferred We are seeking an experienced Workers’ Compensation Defense Attorney for an in-house litigation role supporting claims in the St. Louis region and across a Missouri/Illinois bi-state t…
Skills: Litigation, Workers' Compensation Defense, Legal Writing, Settlement Negotiation, Risk Assessment
Lansing, Michigan, United States · On-site
SUMMARY: Primarily responsible for supporting the management of the all files by analyzing, indexing, e-indexing, and assigning a sub document type to all documents received by Departments within the Enterprise. Also res…
Skills: Document Analysis, Indexing, Data Entry, Medical Terminology, Legal Terminology
Lansing, Michigan, United States · On-site
$65k–$109k/yr
SUMMARY: Claim Representative III: This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large,…
Skills: Workers' Compensation Claims, Claim Investigation, Negotiation, Case Settlement, Reserve Determination
Lansing, Michigan, United States · Remote OK
$57k–$115k/yr
SUMMARY This position is responsible for performing basic data analysis, requirements gathering, and documentation to support business and technical initiatives. The ideal candidate will work under supervision, applying …
Skills: Data Analysis, SQL, Requirements Gathering, Data Profiling, Agile Methodology
Lansing, Michigan, United States · On-site
$83k–$139k/yr
SUMMARY Primary responsibilities of a Litigation Specialist/Senior Claims Representative – Legal handling construction defect claims includes, but is not limited to coverage analysis, collaboration with internal and exte…
Skills: Coverage Analysis, Litigation Management, Legal Research, Claims Adjusting, Negotiation
Lansing, Michigan, United States · Remote OK
$134k–$224k/yr
SUMMARY: Workers Compensation Defense Attorney needed for fully remote in-house litigation position, working under the direction of the General Counsel. This attorney will work defending litigated Workers’ Compensation c…
Skills: Workers Compensation Defense, Litigation, Legal Research, Case Management, Negotiation
Lansing, Michigan, United States · On-site
SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job) This is an entry-level position. This position leads to a Medical Only Claims Specialist I and is expected to last up to 12 months. Upon compl…
Skills: Claims Investigation, Medical Terminology, Workers Compensation, Customer Service, Analytical Skills
Lansing, Michigan, United States · On-site
SUMMARY: Provider Relations Specialist I Responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment i…
Skills: Customer Service, Medical Billing, Medical Coding, Telephone Etiquette, Data Entry
Lansing, Michigan, United States · Remote OK
SUMMARY This position will provide legal assistance to the attorneys representing the Enterprise in all aspects of legal case preparation and file management including legal research; analyzing law sources such as statut…
Skills: Legal Research, Case Preparation, File Management, Drafting Legal Documents, Witness Interviewing
Lansing, Michigan, United States · Hybrid
The Analyst is responsible for assisting and offering assistance in organizing and facilitating strategic program creation and execution. This role assists in researching and compiling appropriate and relevant data and f…
Skills: Analytical Skills, Planning, Problem Solving, Verbal Communication, Written Communication
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The Clinical Pharmacist manages prescription drug claims utilization and educates physicians to optimize prescribing patterns and reduce benefit payouts. They serve as a liaison for medical policy development and support clinical initiatives such as NCQA and HEDIS measures.
Requires a Bachelor's or Doctorate in Pharmacy and a current unrestricted Pharmacy License. Candidates need three years of consulting experience or completion of an accredited pharmacy residency.
PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $107,000 and $179,300.
EEO Statement: All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract.
Making lives healthier, safer and better — together
Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions and services to support our key stakeholders — individuals, employers, providers and strategic partners — improving the health and safety of the people and places we serve. At Emergent Holdings, we’re inspired to create, to challenge the status quo, to think not just about what our customers need now, but what they will need in the future. We are strategic thinkers. We are industry innovators. We are market trendsetters. Together, we are Emergent Holdings. Our team of established industry experts embraces a culture of innovation and entrepreneurial spirit. That means we’re focused on innovation, on leading and shaping our markets and improving health and safety for our customers and communities. For our customers, the result is a suite of solutions, services and products delivered ahead of market needs — and in anticipation of member demands. We are tireless in our pursuit of the exceptional, and our companies deliver optimal customer experiences and improve people’s lives every day, by making workplaces safer and delivering affordable, solutions-focused healthcare services.
Offices: 200 N Grand Ave, Lansing, Michigan 48933, US
Making lives healthier, safer and better — together
Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions and services to support our key stakeholders — individuals, employers, providers and strategic partners — improving the health and safety of the people and places we serve. At Emergent Holdings, we’re inspired to create, to challenge the status quo, to think not just about what our customers need now, but what they will need in the future. We are strategic thinkers. We are industry innovators. We are market trendsetters. Together, we are Emergent Holdings. Our team of established industry experts embraces a culture of innovation and entrepreneurial spirit. That means we’re focused on innovation, on leading and shaping our markets and improving health and safety for our customers and communities. For our customers, the result is a suite of solutions, services and products delivered ahead of market needs — and in anticipation of member demands. We are tireless in our pursuit of the exceptional, and our companies deliver optimal customer experiences and improve people’s lives every day, by making workplaces safer and delivering affordable, solutions-focused healthcare services.
Offices: 200 N Grand Ave, Lansing, Michigan 48933, US
