- Molina Healthcare (Sterling Heights, MI)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Molina Healthcare (Warren, MI)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Molina Healthcare (Warren, MI)
- …Typically does not entail heavy negotiations. Minimal ongoing engagement after contract. Synchronizes data among multiple claims systems when applicable, and ... accurate and timely maintenance of critical provider information on all claims and provider databases. Responsible for contracting/re-contracting of standard deals,… more
- Molina Healthcare (Sterling Heights, MI)
- … systems to support executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...evaluate the impact of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical… more
- Elevance Health (Dearborn, MI)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- Henry Ford Health System (Troy, MI)
- …applications, data , and tools. + Advance analytical skills. + Knowledge of medical claims data and managed care membership data . + Knowledge of ... GENERAL SUMMARY: The Senior Medical Economic Analyst plays a critical role...analyzing healthcare utilization and medical cost trends to support data driven decision-making within the health plan. Responsibilities include… more
- Walgreens (Sterling Heights, MI)
- …by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered ... the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and… more
- HTC Global Services Inc (Dearborn, MI)
- …other perks. Description: This role involves a blend of business analysis, data engineering, and software development, focusing on the migration and enhancement of ... the DuckCreek Claims system to the Origami platform. Key responsibilities include:...translate those into technical requirements for software solutions. + Data Engineering & Migration: Designing and implementing data… more
- Molina Healthcare (Warren, MI)
- …that internal teams and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and ... gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior individual contributor with the charter to build a focused CTM… more