- Cognizant (Raleigh, NC)
- 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
- Robert Half Accountemps (Raleigh, NC)
- Description We are looking for a detail-oriented Medical Claims Analyst to join our team in Raleigh, North Carolina. This long-term contract position is ideal ... high- quality results. Responsibilities: * Process and reconcile medical claims efficiently, ensuring all records are accurate and up-to-date. * Resubmit… more
- Evolent (Raleigh, NC)
- …**What You Will Be Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, ... working seamlessly with diverse teams and stakeholders. + Familiarity with healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions is seeking a Senior Quality Analyst , who will oversee contract and benefit configuration to ensure accurate ... claims processing and network compliance. This is a remote...our people are committed to the improvement of how healthcare is accessed and delivered. When you join our… more
- Elevance Health (Durham, NC)
- **Performance Quality Analyst II** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, ... accommodation is granted as required by law. The **Performance Quality Analyst II** is responsible for driving...claims and/or customer contact automated environment (preferably in healthcare or insurance sector), including a minimum of 1… more
- Prime Therapeutics (Raleigh, NC)
- …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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role We are seeking an enthusiastic, results-oriented Enterprise Sr. Business Analyst /Product Specialist in the healthcare payer domain of Health Plan ... payer domain or Health Plan Administration (Benefits & Claims Administration, Vendor integration, Portals) and Healthcare ...Minimum 7 years of experience as a Senior Business Analyst or Product Specialist in healthcare payer… more
- Motion Recruitment Partners (Garner, NC)
- …HEDIS metrics + Helping to maintain the processes that ingest and integrate claims and clinical data to produce quality metrics and associated care ... Senior Data Analyst / HEDIS Garner, North Carolina **100% Remote**... to support the team responsible for generating HEDIS quality metrics/care gaps and reporting data to respective payers.… more
- The Cigna Group (Charlotte, NC)
- …with local healthcare providers-physicians, hospitals, clinics, and other healthcare facilities-to help deliver high- quality , cost-effective healthcare . ... and negotiate contracts, initiate new agreements, and contribute to building strong healthcare provider networks. **As a Network Contracting Analyst , you will:**… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role We are seeking a passionate, results-oriented Business Analyst in the healthcare payer domain with Multi-employer Trust or Health Plan ... for client or product. The ideal candidate will have worked in-depth in healthcare payer domain in Multi-employer Trust (Hours & Eligibility management), Health Plan… more
- Prime Therapeutics (Raleigh, NC)
- …data consolidation and modeling + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + Experience ... and drives every decision we make. **Job Posting Title** Data and Reporting Analyst Assoc- REMOTE **Job Description** The Associate Data & Reporting Analyst … more
- Highmark Health (Raleigh, NC)
- …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
- Prime Therapeutics (Raleigh, NC)
- …and drives every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance ... Analyst assists in the implementation of Prime's compliance programs,...stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with business… more
- Evolent (Raleigh, NC)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... and estimate Evolent's ability to reduce costs and improve quality . + Develop models to quantify and articulate value...health, biology) + 1+ years of professional experience in claims -based healthcare analytics with a payer, provider,… more
- CVS Health (NC)
- …collaborate with non-par providers to negotiate the pricing of medical and facility claims to obtain the highest possible success rates, resulting in savings for ... both the member and Aetna. As a Negotiator Analyst , you will: + Communicate with providers via phone,...prioritize incoming workload to ensure turn-around time, productivity and quality metrics and met. + Work to obtain information… more
- Centene Corporation (Rocky Mount, NC)
- …report scheduler ideally Active Batch.. Knowledge in the different areas of Healthcare (credentialing, claims , authorizations, telephonics, quality ) Pay ... operations in all or some of the following areas: claims , provider data, member data, clinical data, vision/dental or...federal and state deliverable reporting requirements by performing data quality audits and analysis. + Assist with training and… more
- CVS Health (NC)
- …accordance with company standards while meeting and exceeding accessibility, compliance, quality , and cost initiatives. Verifies contract compliance and adherence to ... metrics and training to ensure compliance with the company's regulatory, safety, quality , and confidentiality protocols and standards. + Ensures a high level of… more
- Evolent (Raleigh, NC)
- …You Will Be Doing:** + **Strategic Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, ... monthly, quarterly, and annual client reporting. In addition to quality review and client Q & A reporting. +...areas of sensitivity + 2 years of Account Management healthcare experience To ensure a secure hiring process we… more
- Highmark Health (Raleigh, NC)
- …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
- CVS Health (NC)
- …Experience in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data ... We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a...skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste,… more