- JS Perkins Consulting (Falls Church, VA)
- …Here is the Role: JS Perkins Consulting (JSPC) is seeking to hire a Budget Analyst to support the Defense Health Agency (DHA) Office of General Counsel (OGC) in its ... improve financial oversight and increase collections through the Medical Affirmative Claims (MAC) and Third-Party Collections (TPC) programs. This role will provide… more
- Cognizant (Richmond, VA)
- 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
- Evolent (Richmond, VA)
- …**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
- Elevance Health (Richmond, VA)
- **Senior Healthcare Economics Analyst ** **Location:** Chicago, IL; Atlanta, GA; Indianapolis, IN; Richmond, VA (preferred). This role requires associates to be ... position is not eligible for current or future visa sponsorship._ The **Senior Healthcare Economics Analyst ** (Advanced Analytics Analyst Senior) creates… more
- Prime Therapeutics (Richmond, VA)
- …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
- Prime Therapeutics (Richmond, VA)
- …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
- Elevance Health (Norfolk, VA)
- …to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and ... **Provider Contract Cost of Care Analyst Senior** **Location:** This role requires associates to...of care issues to help reduce costs without compromising quality of care. **How you will make an impact:**… more
- Highmark Health (Richmond, VA)
- …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 (Richmond, VA)
- …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
- Somatus (Mclean, VA)
- …Analytics to create impact among Somatus' clients and leadership by analyzing Somatus' healthcare claims and care management data. This position will work ... grow, and be the best version of themselves, including: + Subsidized, personal healthcare coverage (medical, dental vision) + Flexible Paid Time Off (PTO) + 401(k)… more
- Evolent (Richmond, VA)
- …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 (VA)
- …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 (Richmond, VA)
- …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 (Richmond, VA)
- …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 (VA)
- …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
- The Cigna Group (Richmond, VA)
- …the office or visit Providers 3 days per week The **Provider Contracting Lead Analyst ** serves as an integral member of the Provider Contracting Team and reports to ... of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales… more
- Public Consulting Group (Richmond, VA)
- …**Duties and Responsibilities** + Provides leadership, management, and direction to the Quality Assurance Analyst team. + Leads and manages department providing ... Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory...Studies + Cost Settlement and Supplemental Payment Strategies + Healthcare Access and Markets A Test Leader oversees the… more
- Prime Therapeutics (Richmond, VA)
- …information from research sources including the internet, trade publications, periodicals, analyst presentations, SEC filings, etc. + Support development of analytic ... 5 years of work experience in strategy, research or healthcare + Must be eligible to work in the...simultaneously **Preferred Qualifications** + Experience with large sets of claims data + In-depth knowledge of PBM industry +… more
- Norstella (Richmond, VA)
- …manage a multi‑region product team and partner closely with Engineering, Content/ Analyst teams, Data Science, and Go‑to‑Market to deliver best‑in‑class forecasting, ... Integration** + Partner with Engineering and Data Science to incorporate RWD ( claims , lab, EMR) where it improves forecast accuracy and scenario planning. Champion… more
