- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance **Position Summary:** The HEDIS Network Analyst will support CCA's ability to meet and surpass critical Quality ... department and will have regular interaction with relevant internal Clinical, Quality , and BI departments, while frequently interfacing with Providers within CCA's… more
- Cognizant (Providence, RI)
- 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 (Providence, RI)
- …**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
- Molina Healthcare (Boston, MA)
- …network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens ... **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the...affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary)… more
- Prime Therapeutics (Providence, RI)
- …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization ... passion and drives every decision we make. **Job Posting Title** Sr. AI Business Analyst - Remote **Job Description** **Are you a Business Systems Analyst with… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role ... billing-related certifications **Required Experience (must have):** + 3+ years in healthcare claims processing, provider reimbursement, or payment integrity. +… more
- Prime Therapeutics (Providence, RI)
- …analysis to include 1 year of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare , and/or related field + Must be eligible to ... our passion and drives every decision we make. **Job Posting Title** Pricing Analyst - REMOTE **Job Description** The Pricing Analyst maintains, provides… more
- Evolent (Providence, RI)
- … 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
- Norstella (Providence, RI)
- …seeking a Senior Medical Analyst to join our team and drive data-driven healthcare initiatives. In this role, you will leverage your expertise in healthcare ... Sr. Medical Analyst , RWD Company: MMIT Location: Remote, United States...related field. + Experience working with and querying large healthcare databases, including claims , EMR/EHR, and laboratory… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare ? Bring your true colors to blue. Position Summary: This person will identify fraudulent provider/member activity and develop ... the development of investigation targets, proposes new methods of data analytics and healthcare informatics to discover Fraud, Waste and Abuse activities as well as… more
- Prime Therapeutics (Providence, RI)
- …experience, preferably leveraging AI + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... decision we make. **Job Posting Title** Data & Reporting Analyst Principal - Remote **Job Description** The Principal Data...Experience in the implementation of quality process improvement efforts Every employee must understand, comply… more
- Humana (Providence, RI)
- …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
- CVS Health (Woonsocket, RI)
- …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 (Providence, RI)
- …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
- Highmark Health (Providence, RI)
- …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
- Public Consulting Group (Providence, RI)
- …Evaluation Consultant to join our team. This role involves analyzing large healthcare datasets and interpreting results of quality measures, supporting strategic ... analytical methodologies to ensure transparency and repeatability. + Develop and implement claims -based quality metrics to assess the performance of Medicaid… more
- CVS Health (Woonsocket, RI)
- …do it all with heart, each and every day. **Position Summary** The Senior Analyst - Business Analytics will be a detail-oriented individual with strong data analysis ... regulations, review of compliance interpretation, writing business specifications, data quality review, data preparation and compliance to regulatory requirements.… more
- Point32Health (Canton, MA)
- …a leading not-for-profit health and well-being organization dedicated to delivering high- quality , affordable healthcare . Serving nearly 2 million members, ... a leading not-for-profit health and well-being organization dedicated to delivering high- quality , affordable healthcare . Serving nearly 2 million members,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …focus on + Development of initiatives to improve members health and health care quality and moderate claims trends + Design, implementation, and measurement of ... Ready to help us transform healthcare ? Bring your true colors to blue. Position...includes the development and communication of market segment medical claims expense trends with the aim to provide insights… more
- Humana (Providence, RI)
- …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
