- Molina Healthcare (Phoenix, AZ)
- …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
- Canon USA & Affiliates (Phoenix, AZ)
- **Mgr Medical Affairs - Clinical Development Sr - HIT - req1494** **OVERVIEW** Works independently and as part of a dynamic and fast-paced team of clinical and ... and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business,… more
- Sumitomo Pharma (Phoenix, AZ)
- …computer systems . + Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts. + Ensures detailed accuracy ... highly motivated, and experienced individual for the position of Sr . Manager, Medicaid Contract Administration. This position is responsible...of correct data input into company systems . + Maintains… more
- Evolent (Phoenix, AZ)
- …mission. Stay for the culture. **What You'll Be Doing:** Evolent Health is looking for a Sr . Product Owner within our Common Data portfolio to be a key member of ... a technical field or relevant related field + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical data… more
- Evolent (Phoenix, AZ)
- …data using industry-standard metrics. + Process and validate raw unadjudicated claims data . **Qualifications Required and Preferred:** + Bachelor's degree, ... Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems… more
- Evolent (Phoenix, AZ)
- …Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems ... interactions fostering expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. **Qualifications… more
- Molina Healthcare (Phoenix, AZ)
- … 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
- Evolent (Phoenix, AZ)
- …skills + Microsoft Office experience (Excel, Visio) + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical ... You'll Be Doing:** Evolent Health is looking for a Senior Product Owner to be a key member of...key member of the Product team, focused on client data integrations. This individual will play a critical role… more
- Highmark Health (Phoenix, AZ)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... of applications he/she supports, how users use the application, and what other systems integrate with the application. Understands how work is being conducted, and… more
- CVS Health (Scottsdale, AZ)
- …of UiPath, Automation Anywhere (AA), or other RPA tools + 3+ years analyzing claims data and/or other large datasets + 3+ years converting business requirements ... action, and have experience in design thinking, continuous process improvement, systems analysis, solution architecture and development, and data integration.… more
- Molina Healthcare (Phoenix, AZ)
- … 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
- Bank of America (Phoenix, AZ)
- Fraud Analytics and Innovation Senior Analyst Newark, Delaware;Tampa, Florida; Jacksonville, Florida; Charlotte, North Carolina; Phoenix, Arizona **To proceed with ... must be at least 18 years of age.** Acknowledge (https://ghr.wd1.myworkdayjobs.com/Lateral-US/job/Newark/Fraud-Analytics-and-Innovation- Senior -Analyst\_25019343-2) **Job Description:** At Bank of America, we are… more
- Highmark Health (Phoenix, AZ)
- …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. (Phoenix, AZ)
- …- 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
- CVS Health (Phoenix, AZ)
- …Salesforce. + Market and place stop loss policies, negotiating terms based upon claims data , strategy, relationships and cost avoidance/reduction efforts. + Work ... impacts for custom requests. + Manage and interpret operational data and apply to fee development and financial analysis....Meritain products and services along with strong business and systems knowledge. + Reviews work for accuracy and recommends… more
- Iron Mountain (Phoenix, AZ)
- …solutions in records and information management, digital transformation services, data centers, asset lifecycle management, and fine art storage, handling, ... artifacts, extract more from their inventory, and protect their data privacy in innovative and socially responsible ways. Are...costs. This position will report directly to the Global Sr . Commercial Director, and will work closely with members… more
- Molina Healthcare (Phoenix, AZ)
- …that internal teams and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and ... gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior individual contributor with the charter to build a focused CTM… more
- Evolent (Phoenix, AZ)
- …care/service + Familiarity with value-based care and utilization management + Understanding of data systems and the critical thinking skills to solve new ... our culture. **What You'll Be Doing:** + Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to… more
- Otsuka America Pharmaceutical Inc. (Phoenix, AZ)
- …tailor solutions to support individual health needs and improve how people engage. Data is the cornerstone of our platform, connecting people and partners and ... platform across health experience services. This role requires a unique blend of systems thinking, product vision, and startup grit to translate ambiguous needs into… more
- CVS Health (Phoenix, AZ)
- …will help configure and validate pricing setups to ensure accuracy in pharmacy claims adjudication systems by applying established business rules and referencing ... and pricing documentation. In this role, you will work closely with more senior team members and collaborate with internal partners such as Account Management, IT,… more