- Insight Global (Woonsocket, RI)
- Job Description Insight Global is seeking a business systems analyst to sit in Hartford, CT or fully remote but work east coast time zone. This person would ... systems that process close to 1 million in claims a day. Key Responsibilities Include: * Elicit and...day. Key Responsibilities Include: * Elicit and document detailed business and system requirements. * Manage and resolve open… more
- Cognizant (Providence, RI)
- ** Claims Process Executive ( remote )** **JOB PURPOSE:** Claim Processors will review claim submissions, verify information, adjudicate the claim as per claim ... processing guidelines to ensure appropriate payment or denial as per the business requirements. **ESSENTIAL FUNCTIONS** : + Examining and entering basic claims … more
- Prime Therapeutics (Providence, RI)
- …every decision we make. **Job Posting Title** Specialty & Home Delivery Program Claims Analyst- Remote **Job Description** The Specialty & Home Delivery Program ... Claims Analyst is responsible for serving as a subject...inquiries related to specific job function process or support systems and provide documentation and tracking to resolution +… more
- Cognizant (Providence, RI)
- **Facets Benefits and Claims Configuration Lead** **Location: Remote ** **Job ID: 00065904022** **About the role** As a Facets Benefits and Claims ... a valued member of our healthcare technology team and work collaboratively across business and technical stakeholders to ensure accurate claims processing and… more
- Prime Therapeutics (Providence, RI)
- …Title** Sr. AI Business Analyst - Remote **Job Description** **Are you a Business Systems Analyst with an AI background? We are standing up a new AI ... the requirements for changes to Prime's claims systems . **Responsibilities** + Ensure understanding of business ...within project + Educate and advance business systems analyst practice within the Claims IT… more
- Prime Therapeutics (Providence, RI)
- …decision we make. **Job Posting Title** Recovery & Resolution Analyst - Remote **Job Description** The Recovery & Resolution Analyst is responsible for recovering ... agency. This position ensures payment recoveries are accurately processed in Prime's systems for recoupment of audits and investigations performed by the Pharmacy… more
- GovCIO (Providence, RI)
- …Skills and Experience** + Bachelor's degree in engineering, Computer Science, Systems , Business or related scientific /technical discipline or equivalent ... testing strategy, planning, and execution across a portfolio of healthcare systems , ensuring compliance with regulatory standards and delivery of high-quality,… more
- Cognizant (Providence, RI)
- …with Medicare, Medicaid, and third-party guidelines. . Effectively document and log claims /appeals information on relevant tracking systems . Utilize critical ... determination We strive to provide flexibility wherever possible. Based on this role's business requirements, this is a remote position open to qualified… more
- Fallon Health (Worcester, MA)
- …strong background in application development, a passion for solving complex business problems, experience working in a regulatory environment, ideally healthcare and ... Platform (Power Apps, Power Automate, Power BI). + - Collaborate with business analysts and stakeholders to gather requirements and translate them into technical… more
- Molina Healthcare (Worcester, MA)
- …email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business . * Conduct varies surveys related to health assessments and member/provider ... member eligibility and covered benefits, Provider Portal, and status of submitted claims . * Ability to effectively communicate in a professionally setting. **Job… more
- Highmark Health (Providence, RI)
- …supporting the Epic Resolute Hospital Billing application. Responsibilities include business / systems analysis, requirements definition and documentation, system ... provide standardized, comprehensive workflows. Corrects issues, conducts routine maintenance, updates systems with new functionality to meet the end user's needs,… more
- Cardinal Health (Providence, RI)
- ** Remote Hours: Monday - Friday, 7:00 AM - 3:30 PM PST (or based on business need)** **_What Accounts Receivable Specialist contributes to Cardinal Health_** ... is responsible for verifying patient insurance and benefits, preparing and submitting claims to payers, correcting rejected claims , following up on unpaid… more
- Zurich NA (Providence, RI)
- …General Liability and Commercial Auto personal injury cases. At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when ... Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims...have strong computer skills and be able to handle remote team-based work which requires them to use video… more
- Insight Global (Stoughton, MA)
- …Provide phone support to patients by navigating a variety of pharmacy dispensing systems to adjudicate claims , refill medications, and increase adherence in ... is looking for Prior Authorization Technicians to work fully remote in support of one of our large healthcare...systems to input data, perform adjudication on test claims and prepare action plans for follow-up. * Effectively… more
- Humana (Providence, RI)
- …reduction, by increasing the accuracy of provider contract payments in our payer systems , and by ensuring correct claims payment and appropriate diagnosis ... an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a...**Use your skills to make an impact** **WORK STYLE:** Remote /work at home. While this is a remote… more
- Insight Global (Stoughton, MA)
- …Provide phone support to patients by navigating a variety of pharmacy dispensing systems to adjudicate claims , refill medications, and increase adherence in ... is looking for Prior Authorization Technicians to work fully remote in support of one of our large healthcare...systems to input data, perform adjudication on test claims and prepare action plans for follow-up. *Effectively communicate… more
- Ford Motor Company (Providence, RI)
- …organization, this individual will help shape the overall direction of the business , identify growth opportunities, innovate our product set, anticipate, and react ... . Provide deep technical expertise and guidance for all business unit product capabilities serve as a trusted advisor...of the book . Proactively monitor key underwriting and claims metrics to identity emerging risks and opportunities .… more
- Evolent (Providence, RI)
- …+ Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to identify cost drivers, utilization patterns, ... actionable insights. + Communicate technical concepts and implications to internal/external business customers. + Act as a thought partner to senior stakeholders,… more
- Eversource Energy (Westwood, MA)
- …+ Works with key project stakeholders, such as Engineering, Transmission Business , Distribution Business , Station Operations, Procurement and others as ... and communication between Project Management, Engineering, Project Controls, Transmission Business , Distribution Business , Station Operations, Procurement, Legal,… more
- Cognizant (Providence, RI)
- …applications to meet unique business needs. + Familiarity with healthcare payer systems and claims processing. + Ability to mentor junior consultants and ... to provide flexibility wherever possible. Based on this role's business requirements, this is a ** remote position**...this role's business requirements, this is a ** remote position** open to qualified applicants in the United… more