- Molina Healthcare (Madison, WI)
- …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
- Molina Healthcare (Green Bay, WI)
- …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
- Molina Healthcare (Green Bay, WI)
- …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
- Molina Healthcare (Kenosha, WI)
- …Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data , pharmacy data , lab data , and ... **JOB DESCRIPTION** **Job Summary** This Sr . Analyst, Healthcare Analytics role will be responsible...I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + Data… more
- Molina Healthcare (Kenosha, WI)
- …more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, ... **Job Description** **Job Summary** Sr . Analyst, Network Strategy, Pricing & Analytics guides...(including trend analysis) by utilizing NetworX Modeler and ETL systems to support negotiating strategies, modeling current and future… more
- Molina Healthcare (WI)
- … systems to support executive decision-making + Mine and manage information from large data sources + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...reports, and improvement opportunities based on analyses + Provide data driven analytics to Clinical COE, Finance, Claims… more
- Molina Healthcare (Racine, WI)
- … systems to support executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...evaluate the impact of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical… more
- Evolent (Madison, WI)
- …manner that fosters expertise and cooperation.** **Process and validate raw unadjudicated claims data .** **Use programming skills to explore, examine and ... **Familiarity with value-based care and utilization management- Preferred.** **Understanding of data systems and the critical thinking skills to solve… more
- Evolent (Madison, WI)
- …care/service + Familiarity with value-based care and utilization management + Understanding of data systems and the critical thinking skills to solve new ... activities as well as Product Development efforts. **What You'll Be Doing:** + Analyse claims and authorization data to identify trends, calculate cost of care,… more
- Molina Healthcare (Madison, WI)
- … 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
- Molina Healthcare (WI)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data , pharmacy data , and lab data regarding network ... + Healthcare Analyst I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + BI tools To all current Molina employees: If you… more
- Otsuka America Pharmaceutical Inc. (Madison, WI)
- **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
- Otsuka America Pharmaceutical Inc. (Madison, WI)
- …Under the direction of the Director/Associate Director of Clinical Management, the Senior Clinical Study Manager is responsible for the oversight and management of ... assigned trial(s), as assigned.** **Participates in ongoing review of clinical trial data focusing on data integrity, trending and consistency.** **Supports… more
- Enterprise Mobility (Madison, WI)
- …dedicated to making a meaningful difference. **ABOUT THE ROLE** The **Entegral Senior Software Engineer** is responsible for innovating and providing solutions for ... existing solutions. This position interacts not only with customers but also senior management to develop strategy relating to security, scalability, and stability… more
- Highmark Health (Madison, WI)
- …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. (Madison, WI)
- …- 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
- Fujifilm (Madison, WI)
- **Position Overview** The accomplished Senior Corporate Compliance Specialist will support FUJIFILM's Corporate Compliance Program's operations to ensure high ... and implementation of new or updated polices, procedures, or systems to address new risk areas or to improve...action plans, and prepare related reports. + Manage transparency data collection, validation, and reporting process to ensure compliance… more
- Elevance Health (Waukesha, WI)
- **Business Consultant Senior - Coordination of Benefits (COB)** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering ... through effective Coordination of Benefits (COB) for clients. The Business Consultant Senior will be responsible for translating most highly complex and varied… more
- NTT America, Inc. (Madison, WI)
- … data protection and privacy laws. + Experience with Medicaid/Medicare systems processing, including Claims , Provider, and Member Eligibility. Managed Care, ... **Make an impact with NTT DATA ** Join a company that is pushing the...can grow, belong and thrive. **Your day at NTT DATA ** The Production Control Analyst will contribute to the… more
- Humana (Madison, WI)
- …for following established policies. The Supervisor, Encounter Data Management ensures data integrity for claims errors. The Supervisor, Encounter Data ... community and help us put health first** The Supervisor, Encounter Data Management develops business processes to ensure successful submission and reconciliation… more