- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance **Position Summary:** The HEDIS Network Analyst will support CCA's ability to meet and surpass critical Quality ... department and will have regular interaction with relevant internal Clinical, Quality , and BI departments, while frequently interfacing with Providers within CCA's… more
- Cognizant (Boston, MA)
- About the role As a ** Quality Analyst with Healthcare - Claims & Membership experience** . You will make an impact by designing and executing end-to-end ... test strategies that ensure the quality and reliability of healthcare claims and membership applications. You will be a valued member of the Quality … more
- Prime Therapeutics (Boston, MA)
- …drives every decision we make. **Job Posting Title** Specialty & Home Delivery Program Claims Analyst - Remote **Job Description** The Specialty & Home Delivery ... Program Claims Analyst is responsible for serving as...processing or project lifecycle, or related roles in the healthcare or PBM industry + Must be eligible to… more
- Molina Healthcare (Boston, MA)
- …network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens ... **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the...affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary)… more
- Fallon Health (Worcester, MA)
- …Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high- quality , coordinated care and is continually rated among the nation's top ... health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, self-expression, and unique… more
- Prime Therapeutics (Boston, MA)
- …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization ... passion and drives every decision we make. **Job Posting Title** Sr. AI Business Analyst - Remote **Job Description** **Are you a Business Systems Analyst with… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role ... billing-related certifications **Required Experience (must have):** + 3+ years in healthcare claims processing, provider reimbursement, or payment integrity. +… more
- Beth Israel Lahey Health (Charlestown, MA)
- …remote based role. Reporting to the Manager, Patient Financial Services, the Clinical Analyst plays an important role in a high-profile team tasked with handling all ... commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high-level clinical appeal for services in the inpatient and… more
- Dana-Farber Cancer Institute (Boston, MA)
- …. In partnership with Business Strategy, the Senior Business Intelligence Analyst builds claims -based analytical models, integrates clinical and operational ... Chief Health Information Officer. Given access to an extraordinary range of healthcare data (including medical and pharmacy claims , enrollment, EMR, scheduling,… more
- Beth Israel Lahey Health (Charlestown, MA)
- …Director of Epic Patient Financial Services - PB, the Senior Epic Operations Analyst serves as the preeminent Epic analytical resource tasked with improving revenue ... back-end billing functions and workflows, charge generation and capture, claims generation and reconciliation, remittance posting processes, retro adjudication and… more
- Prime Therapeutics (Boston, MA)
- …analysis to include 1 year of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare , and/or related field + Must be eligible to ... our passion and drives every decision we make. **Job Posting Title** Pricing Analyst - REMOTE **Job Description** The Pricing Analyst maintains, provides… more
- Prime Therapeutics (Boston, MA)
- …data consolidation and modeling + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + Experience ... passion and drives every decision we make. **Job Posting Title** Data & Reporting Analyst - REMOTE **Job Description** The Data & Reporting Analyst is… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare ? Bring your true colors to blue. Position Summary: This person will identify fraudulent provider/member activity and develop ... the development of investigation targets, proposes new methods of data analytics and healthcare informatics to discover Fraud, Waste and Abuse activities as well as… more
- Norstella (Boston, MA)
- …(MD/DO), or a related field. + Experience working with and querying large healthcare databases, including claims , EMR/EHR, and laboratory data, in an academic ... Sr. Medical Analyst , RWD Company: MMIT Location: Remote, United States...In this role, you will leverage your expertise in ** healthcare data analytics** to extract meaningful insights from **real-world… more
- CVS Health (Boston, MA)
- …Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health insurance, PBM ... our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team. CVS Health...a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and… more
- Highmark Health (Boston, MA)
- …Developers, and other team members to capture capability needs and drive quality business solutions. Create and maintain deliverables such as business vision, ... years in a relevant operational area (eg customer service, claims , enrollment and billing, etc.) to include 1 -...Insurance Industry + 1 - 3 years in the Healthcare Industry + 1 - 3 years in Lean/Six… more
- Public Consulting Group (Boston, MA)
- …Evaluation Consultant to join our team. This role involves analyzing large healthcare datasets and interpreting results of quality measures, supporting strategic ... analytical methodologies to ensure transparency and repeatability. + Develop and implement claims -based quality metrics to assess the performance of Medicaid… more
- Point32Health (MA)
- …a leading not-for-profit health and well-being organization dedicated to delivering high- quality , affordable healthcare . Serving nearly 2 million members, ... a leading not-for-profit health and well-being organization dedicated to delivering high- quality , affordable healthcare . Serving nearly 2 million members,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …focus on + Development of initiatives to improve members health and health care quality and moderate claims trends + Design, implementation, and measurement of ... Ready to help us transform healthcare ? Bring your true colors to blue. Position...includes the development and communication of market segment medical claims expense trends with the aim to provide insights… more
- Humana (Boston, MA)
- …and help us put health first** The Medicare (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral ... They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of Medicare business… more
