- Molina Healthcare (Phoenix, AZ)
- …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 (Tempe, AZ)
- …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
- Molina Healthcare (Phoenix, AZ)
- …Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business ... rules as they apply to each database. Validate data to be housed on provider databases and ensure...and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. +… more
- Evolent (Phoenix, AZ)
- …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 (Phoenix, AZ)
- … 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
- Intermountain Health (Phoenix, AZ)
- …of actual and budgeted contractual allowances and variances, monitoring of individual claims (logs), etc.). Interacts with HIM, PAS, and hospital finance staff as ... **Qualifications Required** + Demonstrated experience in a role requiring data analysis. + Demonstrates computer skills including spreadsheets, databases, word… more
- Highmark Health (Phoenix, AZ)
- …evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for ... disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services)… more
- Cardinal Health (Phoenix, AZ)
- …and enhance the overall healthcare experience. We are seeking a highly motivated and experienced Senior Data Scientist to join our team as a thought leader and ... data to solve complex business problems on large data sets, integrating multiple systems . At Cardinal...Extensive knowledge of healthcare data , including clinical data , patient demographics, and claims data… more
- Datavant (Phoenix, AZ)
- …designing, developing, and maintaining robust data pipelines for healthcare data including prescriptions, medical claims , MAO4, patient demographics, and ... with the other engineering teams to troubleshoot issues with API's and data exchanges between multiple systems . **What You Need to Succeed** + 5+ years Data … more
- Nammo Defense Systems, Inc (Mesa, AZ)
- …We are seeking a highly motivated individual to fill the role of Senior Contracts Administrator with leadership skills and experience to streamline contract and ... from their inception through completion How you will be rewarded as a Senior Contracts Administrator * Monday-Thursday work week working four 10-hour days * Off… more
- CVS Health (Scottsdale, AZ)
- …of UiPath, Automation Anywhere (AA), or other RPA tools + 3+ years analyzing claims data and/or other large datasets + 3+ years converting business requirements ... action, and have experience in design thinking, continuous process improvement, systems analysis, solution architecture and development, and data integration.… more
- Bank of America (Phoenix, AZ)
- …detection algorithms and systems . Perform regular audits and analysis of transaction data to detect new fraud trends. * Guiding team to Develop new fraud ... Fraud Analytics and Innovation Senior Leader - Client Protection Newark, Delaware;Plano, Texas;...data required for performing analysis. * Partner with claims , policy, strategy, and product teams to deliver … more
- Molina Healthcare (Phoenix, AZ)
- … 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
- Otsuka America Pharmaceutical Inc. (Phoenix, AZ)
- **Position Summary** The Senior Manager of Field Technology will lead the design, optimization, and delivery of field sales reporting platforms and tools. This role ... in ensuring that our field teams have seamless access to accurate, actionable data to drive performance. The role focuses on managing field-facing technology … more
- DriveTime (Tempe, AZ)
- …which provides quality warranty and ancillary products, and a customer-friendly claims process. SilverRock offers a variety of ancillary products and administrative ... contracts, products, and warranties, and over $300 million in claims . **That's Nice, But What's the Job?** **_This is...eligible for hire at this time._** In long, our Senior Analyst, Strategic Analytics are responsible for: + Innovate… more
- Evolent (Phoenix, AZ)
- …SAS, SQL, or similar analytical software to analyze clinical authorization and healthcare claims data * Using analytical tools to integrate various data ... care data including medical, pharmacy and ancillary claims data , membership data , clinical...feasible given data limitations * Understanding of data systems and the critical thinking skills… more
- CVS Health (Phoenix, AZ)
- …of PBM profit levers, underwriting and financial models. + Understanding of healthcare and pharmacy claims data and common tools used to manipulate data . + ... to customers. + Broad knowledge of the overall enterprise infrastructure, including operational systems and data warehouses. + Experience with health plans that… more
- Walgreens (Phoenix, AZ)
- …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
- Highmark Health (Phoenix, AZ)
- …overall business targets or assigned volume of new applications or RFP's.Utilize various systems and tools to obtain necessary data and accurately complete and ... 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… more
- Otsuka America Pharmaceutical Inc. (Phoenix, AZ)
- …- Interacts effectively with internal/external functional business units to gather data and develop documentation required for on-time submissions. - Works closely ... (Word, Excel, PowerPoint, Outlook) and familiarity with electronic document management systems (EDMS). **Competencies** See OPDC Competencies Chart (Level X) **P**… more