- Molina Healthcare (Lexington, KY)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant… more
- WelbeHealth (Frankfort, KY)
- … claims + Must have experience working with CMS and Medicaid healthcare claims + Demonstrated skills within Microsoft Office Applications, including Excel ... ** Claims Audit Analyst ** At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option (PACE) to the… more
- Molina Healthcare (Lexington, KY)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing ... healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms… more
- Molina Healthcare (Lexington, KY)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... strong experience with Benefits and contracts configuration in QNXT + Must have claims processing experience + Knowledge is SQL + Experience is Excel is required… more
- Evolent (Frankfort, KY)
- …Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** Senior Analyst , Healthcare Analytics Consultant The Client Analytics team ... our specialty programs and administrative platform. **Role Overview** The Senior Analyst role on Client Analytics will...Be Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify… more
- Highmark Health (Frankfort, KY)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... identifying, assessing, and mitigating compliance risks. The Analyst will monitor regulatory changes, interpret their impact on operational processes, and implement… more
- Otsuka America Pharmaceutical Inc. (Frankfort, KY)
- …connecting people and partners and strengthening our collective impact on total healthcare . **About This Team** The Data & Technology Delivery Team serves as ... Project health (risks, issues, decisions ) + Communicate with senior leaders on program execution as needed + Demonstrate...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Evolent (Frankfort, KY)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Job Posting: Senior Analyst , Performance Analytics** **Location: Remote** Evolent is seeking a ... Senior Analyst , Performance Analytics to join our...science, or engineering) - Preferred + Professional experience in healthcare analytics (eg medical and pharmacy claims … more
- Prime Therapeutics (Frankfort, KY)
- …passion and drives every decision we make. **Job Posting Title** Sr. Market Pricing Analyst - REMOTE **Job Description** The Senior Market Pricing Analyst ... include 3 years of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare , and/or related field + Previous experience using SQL, SAS,… more
- Humana (Frankfort, KY)
- …community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be ... it expands to accommodate the increased responsibilities. **Responsibilities:** The Senior Business Intelligence Engineer will be primarily responsible for… more
- Prime Therapeutics (Frankfort, KY)
- …every decision we make. **Job Posting Title** Sr. Applied Stars and Quality Analytics Analyst - Remote **Job Description** The Senior Health Data Analyst ... of experience in pharmacy benefits management, reporting & analytics, benefits consulting, healthcare , financial services or related field + Must be eligible to work… more
- Highmark Health (Frankfort, KY)
- …quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of ... questionable claim patterns of renewal clients and issues with competitor's claims experience for prospect clients and develops recommendations to account for… more
- Evolent (Frankfort, KY)
- …You'll Need (Required):** + Bachelor's Degree + 2+ years' experience in healthcare , IT business analyst , and/or product management + Experience working ... You'll Be Doing:** Evolent Health is looking for a Senior Product Owner to be a key member of...+ Microsoft Office experience (Excel, Visio) + Understanding of healthcare data formats (eg, eligibility, claims , configuration,… more