- Elevance Health (Louisville, KY)
- ** Medical Claims Data Integrity Consultant** **Location:** Atlanta, GA; Norfolk, VA; Indianapolis, IN; Chicago, IL; Louisville, KY (preferred). This role ... position is not eligible for current or future visa sponsorship._ The ** Medical Claims Data Integrity Consultant** (Business Information Developer… more
- Waystar (Louisville, KY)
- …Provided leadership on a team that designed, built, or used RCM Revenue Integrity products + Ability to interpret regulatory guidelines from CMS, Tricare, and ... Waystar's healthcare payments platform combines innovative, cloud-based technology, robust data , and unparalleled client support to streamline workflows and improve… more
- Elevance Health (Louisville, KY)
- …-expense spending. The **Business Consultant** is a member of our **Carelon Payment Integrity 's Data Mining Team** , where we utilize advanced analytics to ... in uncovering claims overpayments and guiding clients through implementation of data -driven insights. This individual will be data mining, finding anomalies… more
- Elevance Health (Louisville, KY)
- …-expense spending. The **Business Analyst III** is a member of our **Carelon Payment Integrity 's Data Mining Team** , where we utilize advanced analytics to ... accommodation is granted as required by law._ **Carelon Payment Integrity ** is a proud member of the Elevance Health...claims overpayments and guiding clients through implementation of data -driven insights. This individual will be data … more
- Elevance Health (Louisville, KY)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days… more
- Molina Healthcare (Louisville, KY)
- …criteria for medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the ... claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees...needed. + Fosters Clinical Practice Guideline implementation and evidence-based medical practice. + Utilizes IT and data … more
- CDM Smith (Louisville, KY)
- …claims . This role is critical in evaluating and analyzing financial data related to disaster-related claims , including property damage, business interruption, ... investigations to identify discrepancies, detect potential fraud, and ensure the integrity and fairness of claim settlements. By applying advanced accounting,… more
- Walmart (Shepherdsville, KY)
- **Position Summary ** **What you'll do ** Data and Digital Literacy Possesses knowledge of Data collection modes techniques and tools data analytics To be ... able to carry out the following responsibilities Articulates the levers that influence data Ensures data quality and organizes processes information for analysis… more
- CVS Health (Frankfort, KY)
- …clinicians, and business leaders, to translate complex business questions into clear, data -driven insights. + Ensure data integrity and consistency ... it all with heart, each and every day. The Medical Economics team is looking to add a Application...**utilization metrics** , and **provider performance** + Familiarity with ** claims data ** , **risk adjustment** , or… more
- Molina Healthcare (Louisville, KY)
- …in data analysis. Performs research and deep-dive analysis of complex healthcare claims data , CMS return files, and financial cost, revenue, and vendor ... to reduce errors and rework. + Assist with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps. + Must have a… more
- Humana (Louisville, KY)
- …automating workflows, modernizing legacy platforms, AI chatbots and IVR, and enhancing data integrity to support efficient and accurate insurance services. ... industry. Roles span across Artificial Intelligence, Machine Learning, Software Engineering, Data Engineering, Data Science, Agile Project Management, and… more
- Sedgwick (Louisville, KY)
- …meetings with corporate management, business partners and clients. + Monitors and maintains data integrity . + Thorough knowledge of systems and development and ... growth opportunities. + A diverse and comprehensive benefits offering including medical , dental vision, 401k, PTO and more. \#IT \#informationtechnology \#LI-TS1… more
- Walmart (Louisville, KY)
- …Floor in accordance with Company policies and procedures by properly handling claims and returns, zoning the area, arranging and organizing merchandise, and ... work. + Complies with company policies, procedures, and standards of ethics and integrity by implementing related action plans; using the Open Door Policy; and… more