- Molina Healthcare (Austin, TX)
- …accurate and timely implementation and maintenance of critical information on 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 to business and system requirements of customers as it pertains to contracting,… more
- Providence (Renton, WA)
- …Directors and Officers, Employment Practices, Fiduciary, Property, Cyber, Managed Care, and Auto Claims . The Senior Quality Analyst assists the Claims ... and regulations pertaining to self-insured health care organizations. The Senior Quality Analyst is also responsible for maintaining a claims quality assurance… more
- AIG (Atlanta, GA)
- …AIG, we are reimagining the way we help customers to manage risk. Join us as a Claims Analyst IV to play your part in that transformation. It's an opportunity to ... efficiency. How you will create an impact The Casualty Claims Analyst IV within the Lexington and...investigation, damage evaluation and claim resolution in accordance to regulatory and company standards. + Conducts a thorough investigation… more
- UMB Bank (Kansas City, MO)
- **Duties & Responsibilities :** Open to hybrid or remote working schedule The Sr Card Fraud Claims Analyst will be a member of the UMB Card Operations team and ... will report directly to the Card Fraud Claims Manager. Responsibilities of this position will include supporting...to ensure compliance with Reg E and Reg Z regulatory requirements. Serving as back-up for working basic reconciliation… more
- Highmark Health (Frankfort, KY)
- …medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information ... evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for… more
- CenterLight Health System (NY)
- JOB PURPOSE: The Claim Analyst will play a pivotal role in enhancing the efficiency and effectiveness of the claims department by evaluating and refining ... guidelines. This position requires a working knowledge of Government Programs medical claims payment system and configuration with strong focus on data review and… more
- Prime Therapeutics (Boise, ID)
- …fuels our passion and drives every decision we make. **Job Posting Title** Treasury Claims Analyst Senior - Remote **Job Description** The Senior Treasury Claim ... Analyst is responsible for supporting the claim payment process, completing regulatory requirements for pharmacy and member payments. This position performs… more
- Molina Healthcare (Cleveland, OH)
- … claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads ... claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual… more
- Healthfirst (NY)
- …terms, prepare fee schedules and accurately document file changes into the claims processing system + Research and identify published updates to payment ... methodologies, fee schedules and claims editing policies from Medicare, Medicaid, and third-party sources. + Responsible for the overall success of implementations… more
- Cognizant (Frankfort, KY)
- …IT organization and lead changes to such specifications (with senior business analyst oversight through peer reviews); Develop an informed knowledge of the business ... all regulations and requirements. **Essential Functions:** + 3+years Medicare/Medicaid regulatory healthcare experience + Knowledge of claim adjudication processes… more
- Unilever (El Segundo, CA)
- …infinite supply of Liquid IV for extraordinary hydration. **About the role:** The Regulatory Affairs (RA) Analyst is responsible for ensuring compliance of raw ... product documentation, and finished product packaging with internal specifications and external regulatory requirements. The RA Analyst will work closely with… more
- University of Miami (Miami, FL)
- …of Miami/UHealth Department of SCCC has an exciting opportunity for a Full Time Remote Regulatory Analyst 1. CORE JOB SUMMARY: The SCCC department is seeking a ... Regulatory Analyst 1 that will be responsible...Regulatory Analyst 1 that will be responsible for conducting the...revised treatment matrix which will identify possible cancers from claims data. The RA1 will facilitate the process of… more
- University of Miami (Miami, FL)
- …of Miami/UHealth Department of SCCC has an exciting opportunity for a Full Time Regulatory Analyst 1 to work remotely. CORE JOB SUMMARY The Regulatory ... and tests the revised treatment matrix to identify possible cancers from claims data. CORE JOB FUNCTIONS Analyzes regulatory requirements, identifies potential… more
- Zelis (Plano, TX)
- …interests that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory Pricer ... an accurate and timely fashion. What you'll do: + Research and decipher regulatory sources such as legislative rules, state registers, waiver programs and bulletins… more
- Trinity Health (Albany, NY)
- …Type:** Full time **Shift:** Day Shift **Description:** **TITLE** Risk Analyst /Specialist **DEPARTMENT:** Clinical Quality & Safety **REPORTS TO:** Risk Manager ... being faithful to who we say we are. **POSITION SUMMARY** The Risk Analyst is primarily responsible for supporting non-clinical risk management activities in both… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …area/out of network non-par claims . In the course of this work, the Analyst will be required to work closely with others to assemble and produce documentation ... with sound and ethical procedures, objectives and controls, a Network Services Analyst analyzes and evaluates the composition and characteristics of Health Plan… more
- Elevance Health (Wallingford, CT)
- …non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring ... and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize...regulatory standards and requirements. + As such, the analyst will strictly follow department guidelines and tools to… more
- AIG (Boston, MA)
- Join us as a Claims Analyst IV to take on key responsibilities within a world-class claims function. Make your mark in Claims As a Claim Analyst IV, ... be responsible for handling all aspects of multi-line, financial lines claims from inception through conclusion brought against insureds. The responsibilities for… more
- Prime Therapeutics (Eagan, MN)
- …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization ... and drives every decision we make. **Job Posting Title** Sr. Business Systems Analyst **Job Description** The Sr. Business Systems Analyst (BSA) is responsible… more
- St. Luke's Health System (Boise, ID)
- **Overview** **Position Summary:** The Epic Tapestry Analyst - Health Plan AP Claims is responsible for supporting the build, configuration, maintenance, and ... Tapestry module, with a specialized focus on the Health Plan Accounts Payable (AP) Claims functionality. This role ensures the integrity and efficiency of claims … more