- Cognizant (Providence, RI)
- 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 (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...processing or project lifecycle, or related roles in the healthcare or PBM industry + Must be eligible to… more
- Evolent (Providence, RI)
- …**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
- Prime Therapeutics (Providence, RI)
- …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
- Evolent (Providence, RI)
- … 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
- Prime Therapeutics (Providence, RI)
- …data consolidation and modeling + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + Experience ... and drives every decision we make. **Job Posting Title** Data and Reporting Analyst Assoc- REMOTE **Job Description** The Associate Data & Reporting Analyst … more
- Prime Therapeutics (Providence, RI)
- …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
- Evolent (Providence, RI)
- …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 (Woonsocket, RI)
- …service orientation and attention to detail. **Preferred Qualifications** + Background in healthcare or claims processing experience. + Experience with Aetna ... technical expertise with strong communication and problem-solving skills to deliver high- quality support and drive continuous improvement. + Respond promptly and… more
- Evolent (Providence, RI)
- …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 (Providence, RI)
- …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 (Woonsocket, RI)
- …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
- CVS Health (Woonsocket, RI)
- …do it all with heart, each and every day. **Position Summary** The Senior Analyst - Business Analytics will be a detail-oriented individual with strong data analysis ... regulations, review of compliance interpretation, writing business specifications, data quality review, data preparation and compliance to regulatory requirements.… more
- Prime Therapeutics (Providence, RI)
- …information from research sources including the internet, trade publications, periodicals, analyst presentations, SEC filings, etc. + Support development of analytic ... 5 years of work experience in strategy, research or healthcare + Must be eligible to work in the...simultaneously **Preferred Qualifications** + Experience with large sets of claims data + In-depth knowledge of PBM industry +… more
- Norstella (Providence, RI)
- …manage a multi‑region product team and partner closely with Engineering, Content/ Analyst teams, Data Science, and Go‑to‑Market to deliver best‑in‑class forecasting, ... Integration** + Partner with Engineering and Data Science to incorporate RWD ( claims , lab, EMR) where it improves forecast accuracy and scenario planning. Champion… more