- WelbeHealth (Des Moines, IA)
- …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
- Principal Financial Group (Des Moines, IA)
- **What You'll Do** As a **Claim Analyst 2 on our Specialty Product Team** , you'll have the opportunity to review, analyze, and make appropriate and accurate ... decisions on Accident, Critical Illness, Health Screenings and Hospital Indemnity claims in accordance with the policy and state/federal laws and regulations. This… more
- Highmark Health (Des Moines, IA)
- …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
- Molina Healthcare (Des Moines, IA)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... develops reporting solutions to assist HEDIS audit , rate tracking, and Identifying targeted Interventions and tracking...and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality… more
- Molina Healthcare (Des Moines, IA)
- …in Connecticut** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost ... in response to approved change requests; retain old and new report design for audit trail purposes. + Analyze data sets and trends for anomalies, outliers, trend… more
- Molina Healthcare (Des Moines, IA)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate… more
- Highmark Health (Des Moines, IA)
- …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