- Norstella (Frankfort, KY)
- Sr. Medical Analyst Company: MMIT Location: Remote, United States Date Posted: Jul 17, 2025 Employment Type: Full Time Job ID: R-1344 **Description** **Why ... support patients in need. We are seeking a Senior Medical Analyst to join our team and...extract meaningful insights from real-world data (RWD) sources, including claims , laboratory results, billing codes, and electronic health records… more
- Molina Healthcare (Lexington, KY)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical… more
- CVS Health (Frankfort, KY)
- …+ Determines coverage, verifies eligibility, benefits, identifies discrepancies, and applies all Medical Claim Management policies and procedures to assist in ... accurately and efficiently. + Customer service experience + Knowledge of Medical Terminology **Preferred Qualifications** + Claims processing experience +… more
- CVS Health (Frankfort, KY)
- …including Excel and Microsoft Word **Preferred Qualifications** -2-4 years experience as a medical assistant, office assistant or claim processor -ATV, HRP, or ... day. **Position Summary** -Responsible for initial review and triage of claims tasked for review. -Determines coverage, verifies eligibility, identifies and… more
- Molina Healthcare (Lexington, KY)
- …sources. + Resource to staff for mentoring, coaching, and analysis questions. + Reviews Medical Economics analyst work products to ensure accuracy and clarity. + ... strategic analysis. **KNOWLEDGE/SKILLS/ABILITIES** Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise,… more
- Molina Healthcare (Lexington, KY)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... + Experience with Medicare, Medicaid and Marketplace is required. + Medical coding experience is highly preferred. **JOB QUALIFICATIONS** **Required Education**… more
- CVS Health (Frankfort, KY)
- …all with heart, each and every day. **Position Summary** The **PBM Data Analyst ** performs prescription claim and accumulator audits, verifies policy coverage, ... person contributes to the efficient and accurate handling of prescription claims for reimbursement through knowledge of prescription benefits and effective… more
- Cognizant (Frankfort, KY)
- **About the role** As a QNXT Config Analyst , you will make an impact by conducting requirements using QNXT configuration. You will be a valued member of the ... side with client team to add PBPs. + Troubleshoot and remediate/workaround for claim pend issues. + QNXT Configuration for different State implementation + Ability… more
- Evolent (Frankfort, KY)
- …the mission. Stay for the culture. **What You'll Be Doing:** Senior Analyst , Healthcare Analytics Consultant The Client Analytics team provides a unique opportunity ... 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 (Frankfort, KY)
- …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
- Eliassen Group (Frankfort, KY)
- **Sr Guidewire Business Analyst ** **Anywhere** **Type:** Contract **Category:** Business Analysis **Industry:** Insurance **Workplace Type:** Remote **Reference ... Insurance client is looking to bring on a Business Analyst for a long-term contract.The project is working on...consultants, we offer a great benefits package that includes Medical , Dental, and Vision benefits, 401k with company matching,… more
- Intermountain Health (Frankfort, KY)
- **Job Description:** The RCO Revenue Integrity Analyst is responsible for appropriate charge capture, assigned account, claim edits and/or charge edits for an ... ensure regulatory compliance and revenue optimization for assigned service line(s). **Revenue Integrity Analyst I** Schedule: Monday - Friday from 8 AM - 5 PM (with… more
- Molina Healthcare (Lexington, KY)
- **JOB DESCRIPTION** **Job Summary** This Sr. Analyst , Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment ... team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data… more
- Prime Therapeutics (Frankfort, KY)
- …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
- Humana (Frankfort, KY)
- …and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Evolent (Frankfort, KY)
- …team at Evolent. This individual will be primarily focused on performing medical economics analysis in support of complex risk-based contract development and will ... into succinct presentations. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make recommendations based on relevant… more
- Evolent (Frankfort, KY)
- …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
- CVS Health (Frankfort, KY)
- …+ Market and place stop loss policies, negotiating terms based upon claims data, strategy, relationships and cost avoidance/reduction efforts. + Work with leaders ... internal partners. **Required Qualifications** + 1-2 Years of applicable medical insurance experience: brokers (producers), carriers, third-party administrators, benefit… more
- Molina Healthcare (Lexington, KY)
- …the business to provide recommendations on opportunities for process improvements, medical cost savings or revenue enhancements. + Create Business Requirements ... technical teams + Appeals & Grievance, healthcare services, or claims background **Preferred License, Certification, Association** Certified Business Analysis… more
- Highmark Health (Frankfort, KY)
- …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 ... participation percentage, type of industry, characteristics of employee groups, or past claim experience to determine what benefits can be offered and to set… more