- Acosta Group (Jacksonville, FL)
- **DESCRIPTION** The Claims Analyst will assist the Manager of Risk Management in the implementation of the corporation's property and casualty risk management ... communication of programs to business units, and departmental accounting. **RESPONSIBILITIES** The Claims Analyst will support the Risk Management team in… more
- Molina Healthcare (Jacksonville, FL)
- JOB DESCRIPTION Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory ... with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** * Serves as … more
- Molina Healthcare (Jacksonville, FL)
- JOB DESCRIPTION Job Summary Provides lead level analyst support for configuration information management activities. Responsible for accurate and timely ... implementation and maintenance of critical information on claims databases, synchronizing operational and claims systems data and application of business rules… more
- Molina Healthcare (Jacksonville, FL)
- JOB DESCRIPTION Job Summary Provides senior level analyst support for configuration information management activities. Responsible for accurate and timely ... implementation and maintenance of critical information on claims databases, synchronizing operational and claims systems data and application of business rules… more
- Sedgwick (Jacksonville, FL)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance IT Systems Analyst Specialist Sr **PRIMARY PURPOSE OF THE ROLE** : To lead the business ... combination of education and experience required. Experience in multi-line claims management processes and system requirements strongly preferred. Skills &… more
- Robert Half Management Resources (Jacksonville, FL)
- Description We are looking for a skilled Revenue Cycle Analyst to join our team on a contract basis in Jacksonville, Florida. This role involves working closely with ... healthcare revenue cycle processes to ensure accurate medical billing and claims management. If you have experience in healthcare revenue cycles and a strong… more
- Molina Healthcare (Jacksonville, FL)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is… more
- Sedgwick (Jacksonville, FL)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Data Analyst Sr **PRIMARY PURPOSE OF THE ROLE** : To create comprehensive reporting and ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- Sedgwick (Jacksonville, FL)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Data Analyst Manager **PRIMARY PURPOSE OF THE ROLE:** To manage a staff of data ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- Sedgwick (Jacksonville, FL)
- …in Financial Services & Insurance Workforce Analytics & Productivity Monitoring Analyst **PRIMARY PURPOSE OF THE ROLE:** To manage Sedgwick's Workforce Analytics ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- Molina Healthcare (Jacksonville, FL)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS… more
- Molina Healthcare (Jacksonville, FL)
- **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and ... affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable… more
- Molina Healthcare (Jacksonville, FL)
- **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and ... affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable… more
- Molina Healthcare (Jacksonville, FL)
- …in Connecticut** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost ... containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. **KNOWLEDGE/SKILLS/ABILITIES** + Develop ad-hoc reports using SQL programming, SQL Server… more
- Molina Healthcare (Jacksonville, FL)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in… more
- Molina Healthcare (Jacksonville, FL)
- …Analysis_ * Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. * Applies understanding of ... health care regulations, managed care claims workflows, and provider reimbursement models to shape payment...**Required Qualifications** * At least 5 years of business analyst experience in a managed care organization (MCO), and… more
- Syms Strategic Group, LLC (SSG) (Jacksonville, FL)
- …Board (ISTQB), Certified Software Testing Engineer (CSTE), Certified Software Quality Analyst (CSQA)) Years of Professional Experience 10 or more years of ... assurance Desired experience Electronic Data Interchange X.12 (EDI) Medical Claims + X.12 medical claims (837, 834,...X.12 (EDI) Medical Claims + X.12 medical claims (837, 834, 277, etc) A familiarity with cloud-based… more