- Cognizant (St. Louis, MO)
- **QA Analyst in Healthcare Domain with Payer & Claims Testing experience ( Remote )** This is a remote position open to any qualified applicant in the ... We are seeking a highly skilled and motivated **QA Analyst in Healthcare Domain with Payer & Claims...defects, enhancing overall product quality. . Conduct manual end-to-end business process assurance testing, focusing on the Claims… more
- Cognizant (St. Louis, MO)
- **QA Analyst Healthcare Domain - Payer & Claims Testing** This is a remote position open to any qualified applicant in the United States. We are seeking a ... highly skilled and motivated **QA Analyst Healthcare Domain - Payer & Claims ...activities ensuring efficient workflow and communication. Conduct manual end-to-end business process assurance testing focusing on the Claims… more
- Molina Healthcare (Covington, KY)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... successful implementation of provider engagement programs. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze claims from compliance against contracts, billing, and processing guidelines… more
- Alight (IN)
- …through effective solutions and personal service. **Responsibilities** + Handling claims related to FMLA, disability (STD/LTD), parental leave, personal leave, ... of the leaves. + Managing and processing employee leave claims in compliance with federal, state, and company policies.... and Backend Operations (International Voice /Non-Voice/Blended process) + Analyst Level hires: **5 - 8 years** of work… more
- TEKsystems (Earth City, MO)
- …expertise in a professional setting, helping customers and dealerships navigate vehicle repair claims . As a Mechanical Claims Analyst , you'll use your ... of engines, transmissions, and electrical systems to evaluate mechanical claims , communicate with customers and repair facilities, and ensure...Schedule: After initial period, 2 days in-office, 3 days remote (Mondays & Fridays always remote ) +… more
- TEKsystems (Earth City, MO)
- …and part of the larger JM Family Enterprises Inc., is seeking a Mechanical Claims Specialist to join our expanding customer contact team. In this role, you'll ... knowledge of vehicle mechanics to assess and process mechanical claims . This opportunity offers a refreshing change of pace,...connection and a quiet at-home workspace is required for remote and hybrid schedules. Experience with Labor guides -… more
- TEKsystems (Omaha, NE)
- …of the servicer and/or client * Files respective investor/insurer initial and final claims based on the respective guidelines for allowable limits * Reviews MI claim ... and research curtailment reasons for potential rebuttal * Files Appeal or Supplemental Claims ensuring all allowable advances and interest are recovered from the MI… more
- TEKsystems (Ewing, NJ)
- …of the servicer and/or client + Files respective investor/insurer initial and final claims based on the respective guidelines for allowable limits + Reviews MI claim ... and research curtailment reasons for potential rebuttal + Files Appeal or Supplemental Claims ensuring all allowable advances and interest are recovered from the MI… more
- AmeriHealth Caritas (Newtown Square, PA)
- …at www.amerihealthcaritas.com. **Work Arrangement** ; ; ;.; This is a remote position; **Responsibilities:** + Research, analyze, and process projects or ... correspondence for all Lines of Business .;; + Analyze complex operational claim overpayment issues and...resolution.; + Consistently meets or exceeds production standards for Claims Recovery maintaining 99% financial and procedural accuracy.; +… more
- Insight Global (Eden Prairie, MN)
- Job Description An employer is looking for a highly-skilled Financial Data Management Sr Business Analyst to join one of our largest national healthcare clients ... for a remote opportunity. In this role you'll join a growing...and Requirements -Prior experience working as a process focused business analyst -Relevant experience in finance, accounting,… more
- Prime Therapeutics (Indianapolis, IN)
- …and drives every decision we make. **Job Posting Title** IT Business Systems Analyst - ScriptMed - Remote **Job Description** The IT Business Systems ... (SDLC) methodology employed by Prime and partnering with the business , IT, and other project stakeholders to elicit, define,...of security implications of domain + Experience in Prime claims systems + Proficiency in Visio, Microsoft Word, Excel,… more
- Providence (Portland, OR)
- …within the PHP claims editing system. In addition, the Coding Policy Analyst will be responsible for replying to provider and member appeals and providing ... **Description** **Coding Policy Analyst ** **_Remote_** The Coding Policy Analyst ...and assists with implementation of such changes to the claims adjudication and editing software. **Providence Health Plan** caregivers… more
- Molina Healthcare (Provo, UT)
- **Job Description** **Job Summary** We are seeking a highly experienced Lead Analyst , Configuration Oversight to support our Payment Integrity and Claims ... and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen. Experience in… more
- Prime Therapeutics (Eagan, MN)
- …fuels our passion and drives every decision we make. **Job Posting Title** Pricing Analyst - REMOTE **Job Description** The Pricing Analyst maintains, ... with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness &… more
- Prime Therapeutics (Boston, MA)
- …Analyst Sr - Remote **Job Description** The Senior Data & Reporting Analyst is responsible for supporting the business in decision making and operations ... efforts by providing data, reporting and business intelligence services. This role is responsible for acting...experience + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data… more
- Molina Healthcare (Roswell, NM)
- **JOB DESCRIPTION** **Job Summary** This Sr. Analyst , Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment ... team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key ... business issues related to cost, utilization and revenue for...and manage information from large data sources. + Analyze claims and other data sources to identify early signs… more
- Parkview Health (Fort Wayne, IN)
- …of duties associated with payor contracting analytics. Acts as the senior lead analyst mentoring and guiding junior analyst co-workers. Develops and maintains ... key strategic analytical projects. Education: Bachelor's degree in accounting, finance, business or other quantitative field. MBA/MHA a plus. Experience: Minimum of… more
- Molina Healthcare (ID)
- **Job Description** **Job Summary** The Sr Analyst , Risk and Quality Reporting role supports Molina's Risk and Quality Health Plan team. Designs and develops custom ... plan reports related to managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates + Assists and...for the assigned state + Works in an agile business environment to derive meaningful information out of complex… more
- The Cigna Group (Bloomfield, CT)
- …develop and promote shared goals. The Quality Review and Audit Senior Analyst position recognizes experience in Risk Adjustment Data Validation audits (RADV), Risk ... RADV Protocols and Compliance Requirements for RA programs, including EDGE Server Business Rules, where applicable + Demonstrates ability to coordinate with external… more
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