- Lincoln Financial (Juneau, AK)
- …**Requisition #:** 74647 **The Role at a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence team supporting ... coaching and development to perform in this fast-paced environment. As a Claims Customer Care Associate , you will be responsible for answering claimants… more
- Humana (Juneau, AK)
- …and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs ... of decisions to internal associates, and possible participation in care management. May occasionally participate in discussions with external physicians… more
- Evolent (Juneau, AK)
- …a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to ... a mission with a company behind it. **What You'll Be Doing:** ** Associate Director, Performance Analytics - Oncology & Member Product Focus** **Overview:** Evolent… more
- Evolent (Juneau, AK)
- …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...our specialty programs and administrative platform. Role Overview The Associate Director role on Client Analytics will support both… more
- Intermountain Health (Juneau, AK)
- **Job Description:** Provides extraordinary care to our customers through friendly, courteous, and professional service through a broad understanding of account ... + Perform other duties as assigned **Skills** + Insurance Claims + Medical Billing + Explanation of Benefits (EOB)...hourly rate dependent upon experience. $18.81 - $27.45 We care about your well-being - mind, body, and spirit… more
- Humana (Juneau, AK)
- …**Required Qualifications** + Three or more years work experience reading and interpreting claims within a managed care /health care environment + Familiarity ... anomalies in data to identify and collect overpayment of claims . Contributes to the investigations of fraud waste and...are Monday-Friday, 8 hours/day, and 5 days/week in the associate 's home time zone. Some schedule changes/adjustments might be… more
- Humana (Juneau, AK)
- …community and help us put health first** Design and maintain Medicaid claims analytics dataset using Databricks. Conduct in-depth analysis of healthcare claims ... Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. Maintain dashboards to communicate key trends to stakeholders. The… more
- Humana (Juneau, AK)
- …looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and ... provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters… more
- Humana (Juneau, AK)
- …responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Humana (Juneau, AK)
- …achieving operational and compliance key performance indicators. In addition, the associate will participate in cross functional teams and support analyzing business ... an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and… more
- Humana (Juneau, AK)
- …have expertise in conducting retrospective observational studies using administrative claims data using a collaborative approach across multiple stakeholders. Humana ... + An understanding of research methodology and the managed care arena, and how it applies to health outcomes...with cloud base analytics platforms + Experience with clinical, claims , pharmacy or other healthcare data. + Strategic thinking… more
- Humana (Juneau, AK)
- …of the Pharmacy Analytics division, with responsibilities that include working with pharmacy claims data. The team to which this position reports is dedicated to ... PowerBI + Experience in Databricks is preferred + Experience in analyzing pharmacy claims data Travel: While this is a remote position, occasional travel to Humana's… more
- Humana (Juneau, AK)
- …complete and accurate. + Certified Professional Coder or coding knowledge. + Claims knowledge and understanding of claims processing. **Additional Information** ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more
- Highmark Health (Juneau, AK)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy technician ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- Humana (Juneau, AK)
- …health first** **Requires a strong foundation in COBOL mainframe development ** The Claims Adjudication System (CAS) team at Humana is essential in delivering core ... services through effective claims processing and management solutions. This position involves coding software applications based on business requirements and… more
- UMB Bank (Juneau, AK)
- …insurance coverage through Bank's blanket program or external policy, facilitate insurance claims , taxation matters and payment, and that assets are reviewed in ... other insurance coverage; health savings, flexible spending, and dependent care accounts; adoption assistance; an employee assistance program; fitness reimbursement;… more
- Humana (Juneau, AK)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Evolent (Juneau, AK)
- …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...clean and consistent tracking of Evolent's covered membership and claims + Synthesize complex analyses into succinct presentations for… more
- Humana (Juneau, AK)
- …offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & ... APEX, PMPD Provider Search, PAAG (Provider At A Glance), CAS ( Claims Administration System), Mentor experience + Provider installation/directory, provider data… more
- Humana (Juneau, AK)
- …and help us put health first** Join Humana's Utilization Management (UM) & Care Management (CM) Strategy team as a Strategy Advancement Advisor and apply your ... lead priority initiatives that may cut across utilization management, care management and other areas of the business including... management and other areas of the business including claims , product/IT, legal and compliance, etc. As part of… more