- Cognizant (Raleigh, NC)
- 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
- Prime Therapeutics (Raleigh, NC)
- …drives 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...processing or project lifecycle, or related roles in the healthcare or PBM industry + Must be eligible to… more
- Robert Half Accountemps (Raleigh, NC)
- Description We are looking for a detail-oriented Medical Claims Analyst to join our team in Raleigh, North Carolina. This long-term contract position is ideal ... high- quality results. Responsibilities: * Process and reconcile medical claims efficiently, ensuring all records are accurate and up-to-date. * Resubmit… more
- Evolent (Raleigh, NC)
- …**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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions is seeking a Senior Quality Analyst , who will oversee contract and benefit configuration to ensure accurate ... claims processing and network compliance. This is a remote...our people are committed to the improvement of how healthcare is accessed and delivered. When you join our… more
- Prime Therapeutics (Raleigh, NC)
- …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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role We are seeking an enthusiastic, results-oriented Enterprise Sr. Business Analyst /Product Specialist in the healthcare payer domain of Health Plan ... payer domain or Health Plan Administration (Benefits & Claims Administration, Vendor integration, Portals) and Healthcare ...Minimum 7 years of experience as a Senior Business Analyst or Product Specialist in healthcare payer… more
- Motion Recruitment Partners (Garner, NC)
- …HEDIS metrics + Helping to maintain the processes that ingest and integrate claims and clinical data to produce quality metrics and associated care ... Senior Data Analyst / HEDIS Garner, North Carolina **100% Remote**... to support the team responsible for generating HEDIS quality metrics/care gaps and reporting data to respective payers.… more
- Evolent (Raleigh, NC)
- … quality reporting, and benchmarking + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing and ... that fosters expertise and cooperation + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data regarding health plan cost &… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role We are seeking a passionate, results-oriented Business Analyst in the healthcare payer domain with Multi-employer Trust or Health Plan ... for client or product. The ideal candidate will have worked in-depth in healthcare payer domain in Multi-employer Trust (Hours & Eligibility management), Health Plan… more
- Prime Therapeutics (Raleigh, NC)
- …Posting Title** QA Analyst PBM Implementation - Remote **Job Description** The Quality Assurance (QA) Analyst performs complex quality reviews and serves ... GED is required + 2 years of experience within Claims Processing, Audit, Quality or Pharmacy +...Licensed Practical Nurse certification if working in Medicare + Healthcare , audit, and/or reporting and metrics environment experience +… more
- CVS Health (Raleigh, NC)
- …Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health insurance, PBM ... our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team. CVS Health...a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and… more
- Evolent (Raleigh, NC)
- …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 (Raleigh, NC)
- …collaborate with non-par providers to negotiate the pricing of medical and facility claims to obtain the highest possible success rates, resulting in savings for ... both the member and Aetna. As a Negotiator Analyst , you will: + Communicate with providers via phone,...prioritize incoming workload to ensure turn-around time, productivity and quality metrics and met. + Work to obtain information… more
- Evolent (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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
- Elevance Health (Durham, NC)
- …of committed clinicians and business leaders passionate about transforming American healthcare delivery. The **Senior Health Economist (** Advanced Analytics ... Analyst Senior) measures financial performance of core Carelon products leveraging claims , authorization, and membership data to tell a detailed story to… more
- Humana (Raleigh, NC)
- …and help us put health first** The Medicare (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral ... They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of Medicare business… more
- Highmark Health (Raleigh, NC)
- …Java Developer, DB2, Cogno, PEGA, Enterprise Architect(SCEA), Project Management, Certified Quality Analyst (CQA), Scrum Master Certification, Lean/Six Sigma ... complex applications that meet the service levels, system availability, performance and quality levels required by their customers. May mentor less experienced team… more