- Molina Healthcare (New York, NY)
- …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
- Amazon (New York, NY)
- …The Program, Project, Product, and Vendor Management Team within Amazon's Logistics Claims Management and Operations group is seeking a motivated and experienced ... Senior Risk Manager. The ideal candidate will be familiar with insurance and claims programs, and insurance policies, have a history of success in procurement,… more
- Capital One (New York, NY)
- Sr . Distinguished Engineer - Fraud Technology As a Sr . Distinguished Engineer at Capital One, you will be a part of a community of technical experts working to ... on our customers' lives. We are looking for a Senior Distinguished Engineer to define, architect and drive the...Define and drive technical strategy and roadmap for our systems and platforms that power Fraud defenses and Fraud… more
- Terumo Medical Corporation (Somerset, NJ)
- Sr . Manager, Market Intelligence Date: Jun 20, 2025 Req ID: 4800 Location: Somerset, NJ, US, 08873 Company: Terumo Medical Corporation Department: TIS Strategic ... Medical Corporation is comprised of two strategic business divisions: Terumo Interventional Systems and Terumo Medical Products. We believe that the future is bright… more
- Two95 International Inc. (New York, NY)
- …SOW will meet their needs * Lead the discovery of the client's EMR/EHR and/or claims data environment so we can efficiently and effectively navigate and do the ... Job Title: Sr . Analytics Consultant Job type : Remote Work...analyses * Lead the analytical-interrogation of their EMR/EHR and/or claims data to perform data … more
- Terumo Medical Corporation (Somerset, NJ)
- …plans, and provides training and re-training to associates, as needed. + Leverages data analytics tools and create reports for senior management to create ... Sr . Compliance Manager - Monitoring & Transparency Date:...& Medicaid Services (CMS). Performs analytics on CMS available data and provides meaningful insights to senior … more
- Warner Music Group (New York, NY)
- …company that retains the creative spirit of a** **nimble independent.** **Job Title: Sr . Analyst, Financial** **A little bit about our team:** Warner Music Group's ... development opportunities. We're excited to share this new opportunity for a Sr . Analyst, Participations with strong analytical & financial capabilities, to join our… more
- Canon USA & Affiliates (Trenton, NJ)
- **Mgr Medical Affairs - Clinical Development Sr - HIT - req1494** **OVERVIEW** Works independently and as part of a dynamic and fast-paced team of clinical and ... and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business,… more
- Elevance Health (Woodbridge, NJ)
- **Clinical Quality Management Analyst Sr . Behavioral Health** **Location:** 111 Wood Ave. S, Iselin, NJ 08830 **Office Requirement:** This role requires associates ... locations may be considered. The **Behavioral Health Clinical Quality Analyst Sr .** is responsible for developing and conducting more complex behavioral health… more
- Sumitomo Pharma (Trenton, NJ)
- …computer systems . + Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts. + Ensures detailed accuracy ... highly motivated, and experienced individual for the position of Sr . Manager, Medicaid Contract Administration. This position is responsible...of correct data input into company systems . + Maintains… more
- Evolent (Trenton, NJ)
- …mission. Stay for the culture. **What You'll Be Doing:** Evolent Health is looking for a Sr . Product Owner within our Common Data portfolio to be a key member of ... a technical field or relevant related field + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical data… more
- Evolent (Trenton, NJ)
- …data using industry-standard metrics. + Process and validate raw unadjudicated claims data . **Qualifications Required and Preferred:** + Bachelor's degree, ... Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems… more
- PVH Corp. (Bridgewater, NJ)
- …Administration and Operations. Your primary focus will be HRIS administration, data analytics, process management. Programs include health, prescription drug, life, ... third-party administrators, and insurance carriers to resolve issues, process enrollments, claims , and ensure timely service delivery. + Oversee employee eligibility… more
- Evolent (Trenton, NJ)
- …Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems ... interactions fostering expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. **Qualifications… more
- Molina Healthcare (New York, NY)
- … 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
- Evolent (Trenton, NJ)
- …skills + Microsoft Office experience (Excel, Visio) + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical ... You'll Be Doing:** Evolent Health is looking for a Senior Product Owner to be a key member of...key member of the Product team, focused on client data integrations. This individual will play a critical role… more
- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- …data management best practices and implementing desired solutions for the commercial data and analytics domains. **Job Description** The Senior Manager for ... solution design, quality, financial transparency, and best practices. Additionally, the Senior Manager role will collaborate with cross-functional Data &… more
- City of New York (New York, NY)
- …to contracting with government and/or insurance companies. - Experience guiding insurance claims data analysis - Experience in Management Service Organizations, ... impacted NYC communities. CHECW addresses inequity across community and healthcare systems in partnership with community, faith-based, and health care organizations.… more
- City of New York (New York, NY)
- … data warehousing services to constituent divisions of the Finance Office. The Senior Systems Analyst will perform technical and analytical work that will ... seeking an Associate Staff Analyst to function as the Senior Systems Analyst within Management & Policy...and qualitative analysis of special projects from ORMD and senior executive staff. Manage large amounts of data… more
- Highmark Health (Trenton, NJ)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... of applications he/she supports, how users use the application, and what other systems integrate with the application. Understands how work is being conducted, and… more