- TEKsystems (Raleigh, NC)
- TEKsystems is hiring for a fully remote Medical Claims Analyst for a PBM to help analyze and correct medical claims !! Start Date: July 14th MUST ... HAVES: 2+ years of claims experience with emphasis on researching / auditing not...they will succeed in this role. The understanding of medical terminology (Copays, deductibles, and benefit plans) will help… more
- Deloitte (Raleigh, NC)
- …who wants to work in a collaborative environment? As an experienced Epic Billing and Claims Senior Analyst you will have the ability to share new ideas and ... + Certified in Epic Hospital Billing Administration/Professional Billing Administration and Claims + Experience in performing configuration changes and system builds… more
- Cognizant (Raleigh, NC)
- …IT organization and lead changes to such specifications (with senior business analyst oversight through peer reviews); Develop an informed knowledge of the business ... benefits for this position, subject to applicable eligibility requirements: + Medical /Dental/Vision/Life Insurance + Paid holidays plus Paid Time Off + 401(k)… more
- Highmark Health (Raleigh, NC)
- …:** GENERAL OVERVIEW: Applicants Must Be Able to Read and Comprehend Spanish Medical Terminology The Quality analyst is responsible for compiling and analyzing ... data relevant to the handling of all types of complex adjusted claims ; conducting reviews of all organizational or functional activities related to fraud/abuse… more
- Evolent (Raleigh, NC)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Senior Analyst , Healthcare Analytics Consultant** The Client Analytics team provides a unique ... of our specialty programs and administrative platform. **Role Overview** The Senior Analyst role on Client Analytics will support both internal teams (EAS, Specialty… more
- Evolent (Raleigh, NC)
- …science, or engineering) - Preferred + Professional experience in healthcare analytics (eg medical and pharmacy claims data, membership data, or other healthcare ... Stay for the culture. **What You'll Be Doing:** **Job Posting: Senior Analyst , Performance Analytics** **Location: Remote** Evolent is seeking a Senior Analyst… more
- IQVIA (Durham, NC)
- **Flatiron Data Analyst - Real World Solutions** **Job Overview** The senior data analyst sits within our Real-World Solutions team and will be responsible for ... programs and conduct analyses using secondary real world data sources, including claims , EHR, HEOR, and genomic data. + Support development of other study… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Senior Data Analyst , Population Health will be an analytically driven team player, responsible for understanding business needs and objectives, ... Health Management, Utilization Management and Complex Case Management. As Senior Data Analyst , Population Health, you will be challenged to think creatively while… more
- Elevance Health (Durham, NC)
- **Business Information Analyst Senior - Provider Economics** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and ... St. Louis, MO, Louisville, KY or Durham, NC. The **Business Information Analyst Senior** is responsible for analyzing, reporting and developing recommendations on… more
- Humana (Raleigh, NC)
- …and help us put health first** The Senior Financial Reporting Professional/ Analyst prepares and distributes periodic financial statements for users other than those ... directly employed by the organization. The Senior Finance Reporting Professional/ Analyst + Analyzes and forecasts financial, economic, and other data to provide… more
- Prime Therapeutics (Raleigh, NC)
- …or STARS experience + Experience conducting complex analysis on large sets of pharmacy, claims , medical , and/or financial data + Intermediate SAS or SQL coding ... decision we make. **Job Posting Title** Sr. Applied Stars and Quality Analytics Analyst - Remote **Job Description** The Senior Health Data Analyst provides… more
- Cognizant (Raleigh, NC)
- …we're improving everyday life. **Job Title** **:** **FACETS Configuration Analyst ** **Location** **:** **Remote** **Job ID** **: SO#** **00064187821** **Role ... Assurance:** o Conduct unit and integration testing of configurations to ensure accurate claims adjudication. o Collaborate with QA teams to develop test cases and… more
- Prime Therapeutics (Raleigh, NC)
- …and effective solutions to complex business problems. + Experience with healthcare medical and pharmacy claims data manipulation and analysis. + Master's ... every decision we make. **Job Posting Title** Associate Health Informatics Analyst **Job Description** Design, document, develop and roll out financial, clinical… more
- CVS Health (Raleigh, NC)
- …heart, each and every day. **Position Summary** The Corporate Services Analyst will provide legal support, support litigation management, and conduct pre-litigation ... provider contracts and collaborating with the appropriate business partners to ensure claims are processing per those contractual terms. + Extensive knowledge of… more
- Evolent (Raleigh, NC)
- …Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Analyst , Client Analytics** Integrate and analyze claims and enrollment data from ... innovative analytics solutions that drive decision-making for clients by performing medical economics analyses to determine cost and utilization drivers. Showcase… more
- Evolent (Raleigh, NC)
- …Familiarity with health care lines of business and health care data including medical , pharmacy and ancillary claims data, membership data, clinical operational ... SAS, SQL, or similar analytical software to analyze clinical authorization and healthcare claims data * Using analytical tools to integrate various data sources to… more
- Highmark Health (Raleigh, NC)
- …identified opportunities. This position will necessitate clinical informatics and medical knowledge. **ESSENTIAL RESPONSIBILITIES** + Leads the design, development, ... 7 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 5 years of project leadership… more
- Highmark Health (Raleigh, NC)
- …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 ... questionable claim patterns of renewal clients and issues with competitor's claims experience for prospect clients and develops recommendations to account for… more
- CVS Health (Raleigh, NC)
- …**Position Summary** We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a leading health insurance ... analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid regulatory &… more