- CVS Health (Augusta, ME)
- …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
- Highmark Health (Augusta, ME)
- … terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information ... claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim...years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical… more
- Cognizant (Augusta, ME)
- …IT organization and lead changes to such specifications (with senior business analyst oversight through peer reviews); Develop an informed knowledge of the business ... + 3+years Medicare/Medicaid regulatory healthcare experience + Knowledge of claim adjudication processes and Facets platform experience preferred + Experience… more
- WelbeHealth (Augusta, ME)
- The Lead Data Analyst is an analytically heavy hands-on role, utilizing processed business information points as the basis to further define and build out metrics, ... provider and/or payer operations. + Minimum three years' of experience working with claims data and provider network data. + Preferred experience in Health Plan… more
- Central Maine Medical Center (Lewiston, ME)
- …and for each other every day. Central Maine Healthcare is seeking a Payment Analyst to join our Team. This is a full time 40-hour, benefits eligible position. ... rate of pay is $20.00 per hour. The Payment Analyst 's primary responsibility is to research and process payments,...years relevant experience, including knowledge of insurance billing and medical terminology What It's Like Working At CMH: We… more
- Evolent (Augusta, ME)
- …contribute to Evolent's broader mission. **Collaboration Opportunities:** The Senior Analyst , Performance Suite Analytics utilizes and develops analytic tools to ... impact on the organization and patient health. This role supports both Medical Cost Management activities as well as Business Development efforts. Working in… more
- Evolent (Augusta, ME)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Senior Analyst , Healthcare Analytics Consultant** The Client Analytics team provides a unique ... 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 (Augusta, ME)
- …internship + Experience with financial forecasting + Familiarity or experience with medical /pharmacy claims + Familiarity with PowerQuery/BI/VBA + Ability to ... more connected care journey. We are hiring an Actuarial Analyst to join our Actuarial Services Team. **What You'll...Actuarial Services Team. **What You'll Be Doing:** The Actuarial Analyst will inform decision making across the company and… more
- Evolent (Augusta, ME)
- …Stay for the culture. **What You'll Be Doing:** Job Description Senior Analyst , Performance Analytics - **RBM Cardiac** product focus, utilizes and develops analytic ... impact on the organization and patient health. This role supports both Medical Cost Management activities as well as Product Development efforts. **What You'll… more
- Humana (Augusta, ME)
- …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
- The Cigna Group (Augusta, ME)
- …channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, ... RI and ME._** **_Preferred office location: Newton, MA_** The **Provider Contracting Lead Analyst ** serves as an integral member of the Provider Contracting Team and… more
- Highmark Health (Augusta, ME)
- …and scalability and reusability of benefit configurations. Develop and execute claims testing plan, scenarios, documentation and defect management to ensure minimal ... strategy development for new strategic programs. + Research and analyze claims processing problems, perform initial problem identification and resolution activities,… more
- CVS Health (Augusta, ME)
- …+ Applying advanced Excel modeling techniques to analyze large sets of pharmacy claims data and build forward looking financial forecasts and profit and loss (P&L) ... to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and… more
- Highmark Health (Augusta, ME)
- …identified opportunities. This position will necessitate clinical informatics and medical knowledge. **ESSENTIAL RESPONSIBILITIES** + Leads the design, development, ... 7 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 5 years of project leadership… more
- Highmark Health (Augusta, ME)
- …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