- WelbeHealth (Trenton, NJ)
- …Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and ... accurate pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or company policies and procedures. **Essential Job… more
- NJM Insurance (Trenton, NJ)
- …opportunities for improvement to present to management. + Collaborate with the BPU, claims management, law and regulation, and internal audit to ensure the ... Training and Quality Assurance Management Supervisor, the WC Quality Assurance/Compliance Analyst is responsible for ensuring adherence to state and federal… more
- AmeriHealth Caritas (Philadelphia, PA)
- …services. Discover more about us at www.amerihealthcaritas.com . **Responsibilities:** Audit and analyze all Facets configuration changes completed by the ... Review all associated documentation for completeness. Communicate with the configuration analyst , configuration team lead, tester, and requestor as required to… more
- WTW (Philadelphia, PA)
- …**The Role** We are seeking an organized and detail-oriented Retirement Plan Compliance Analyst to join our team. As a compliance analyst you will ... with ERISA regulations and other applicable federal laws. Adhere to audit protocol to ensure accuracy of documentation. **Document Production/Management:** Adhere to… more
- Philadelphia Insurance Companies (Bala Cynwyd, PA)
- …them to achieve their goals. Our talented team delivers actuarial, audit , corporate communications, financial and investment, human capital services, information ... must show a commitment to ongoing professional development as a Business Analyst within the insurance industry. This role requires close collaboration with business… more
- Highmark Health (Trenton, NJ)
- …and training materials specific to underwriting functions, ensuring clarity for audit and compliance. + Collaborate closely with underwriters to analyze existing ... 3 - 5 years of experience in a Business Analyst or Business Process Analyst role or...role or experience in a related operational area (eg claims , billing, customer service, etc.) **Preferred** + Experience in… more
- Philadelphia Insurance Companies (Bala Cynwyd, PA)
- …them to achieve their goals. Our talented team delivers actuarial, audit , corporate communications, financial and investment, human capital services, information ... maintenance, large account pricing, and product development. The Actuarial Analyst needs to be able to work with internal...Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii,… more
- Insight Global (Mount Laurel, NJ)
- …the organization. The team focuses on root cause analysis to ensure clean claims and accurate revenue capture. Analysts will conduct charge audits, identify workflow ... master, coding and billing guidelines (including CPT codes), and internal audit processes. Technical expertise in Epic is strongly preferred, particularly in… more
- Philadelphia Insurance Companies (Bala Cynwyd, PA)
- …them to achieve their goals. Our talented team delivers actuarial, audit , corporate communications, financial and investment, human capital services, information ... the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an… more
- Philadelphia Insurance Companies (Bala Cynwyd, PA)
- …them to achieve their goals. Our talented team delivers actuarial, audit , corporate communications, financial and investment, human capital services, information ... the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an… more
- Highmark Health (Trenton, NJ)
- …with a general understanding of data flows from various corporate systems (eg, claims , billing, lab, and Rx), to solve complex issues and problems. A comprehensive ... include but not limited to, review/editing of content submissions and best practices, audit reports, etc. The incumbent is expected to make major contributions to… more
- AmeriHealth Caritas (Philadelphia, PA)
- …is responsible for overseeing the day-to-day operations of the Operations Quality Analyst team within the Community Health Choices program. This role ensures ... Supervise and provide coaching to Quality Analysts on production, quality, and audit resolution. + Coordinate work distribution and monitor inventory to ensure… more