- Cognizant (Augusta, ME)
- 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
- Evolent (Augusta, ME)
- …**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
- Evolent (Augusta, ME)
- … 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
- CVS Health (Augusta, ME)
- …Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health insurance, PBM ... our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team. CVS Health...a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and… more
- Evolent (Augusta, ME)
- …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
- Evolent (Augusta, ME)
- …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 (Augusta, ME)
- …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
- Humana (Augusta, ME)
- …and help us put health first** The Medicare (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral ... They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of Medicare business… more
- Highmark Health (Augusta, ME)
- …Java Developer, DB2, Cogno, PEGA, Enterprise Architect(SCEA), Project Management, Certified Quality Analyst (CQA), Scrum Master Certification, Lean/Six Sigma ... complex applications that meet the service levels, system availability, performance and quality levels required by their customers. May mentor less experienced team… more
- Norstella (Augusta, ME)
- …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