- Centene Corporation (Austin, TX)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Oversee the claims configuration and pricing/benefits set up within the claims ... Technology or related field or equivalent experience. 7+ years of configuration , claims adjudication, pricing/benefits setup, or contracting experience.Pay… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …data used for reimbursement configuration , validation of provider reimbursement configuration and to support research of claims . + Attend, participate ... we encourage you to apply! Job Description: Summary: The Reimbursement Configuration Analyst is responsible for utilizing system development methodologies to… more
- UCLA Health (Los Angeles, CA)
- …or equivalent work experience + Minimum of seven years of Health Plan claims adjudication and provider contract configuration /analysis required + Minimum of ... three years of experience specific to Epic/Tapestry system claims adjudication and provider contract configuration required + Experience in leading,… more
- Commonwealth Care Alliance (Boston, MA)
- …for One Year Term **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims ... small to large Operations Management + Collaborate system and data configuration into CES ( Claims Editing System) with BPaaS vendor and other PI partners,… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role ... the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …growth, with a strong emphasis on quality control and improvements to enhance claims processing stability, flexibility, and innovation. The Director will be ... About The Role The Director of Application Support and Quality Assurance will...Payer or TPA setting. + Extensive background in understanding claims system configuration including, benefit plans, accumulator… more
- Clay Lacy Aviation (Van Nuys, CA)
- …unwavering integrity, and a commitment to excellence. We are seeking a forward-thinking Director of Total Rewards who shares our passion for elevating every detail ... that's redefining what it means to be thoughtfully better. Position Summary The Director of Total Rewards is a strategic leader responsible for the compliant,… more
- Otsuka America Pharmaceutical Inc. (Rockville, MD)
- **Position Title: Associate Director , Senior Platform Lead (Rockville, MD)** **Responsibilities:** Lead the Otsuka platform team by providing operational and program ... operational and project costs, including but not limited, to development/ configuration work effort and timelines, hosting costs, and licenses...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- AIG (Charlotte, NC)
- …is at the heart of everything we do, from underwriting risks to processing claims . The Information Technology team equips our employees with the latest tools to ... and compliance. How you will create an impact The Director GI International Quality Engineering & Assurance is critical...development principles. + Support key programs such as SCUP, Claims , Japan Transformation, myAIG etc. + Working knowledge of… more
- CenterLight Health System (NY)
- …for internal and external customers. + Keep abreast with any updates to claims payment configuration requirements from both governmental agencies (NYS DOH and ... JOB PURPOSE: The Assistant Director , Revenue Cycle is responsible for the management...ESRD, and Nursing Home entitlements. + Perform membership and claims analytics, including IBNR, MMR and 820/834 reconciliation. +… more
- City of New York (New York, NY)
- …for (1) Administrative Staff Analyst NM III to function as an Executive Director , Data Analytics & Verification who will: - Oversee the management, administration, ... the analysis, design, specification, and cost analysis for installation, configuration , operation, support and maintenance of software/applications. Oversee software… more
- Molina Healthcare (Everett, WA)
- …management and business analyses of national contracts/benefits to support accurate configuration for claims payment); Provider/Member Inquiry Research and ... Resolution; and Provider/Member Appeals and Grievances. * Coordinates with Corporate and Business Development teams to ensure that Molina grows faster (profitable growth) than our competitors in target new markets and expansion opportunities. * Provides… more
- Sharp HealthCare (San Diego, CA)
- …in a health insurance product implementation, benefit/coverage policy development, benefit configuration , or claims role. **Other Qualification Requirements** + ... and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit… more
- US Pacific Fleet (San Diego, CA)
- Summary You will serve as a SUPERVISORY LOGISTICS MANAGEMENT SPECIALIST in the DIRECTOR LOGISTICS, FLEET SUPPLY & ORDNANCE of COMMANDER US PACIFIC FLEET. The ... logistics training, repair part material availability, budget preparation and equipment configuration management. + You will direct and supervise Pacific Fleet's… more
- Beth Israel Lahey Health (Charlestown, MA)
- …job, you're making a difference in people's lives.** Reporting to the Executive Director of Epic Patient Financial Services - PB, the Senior Epic Operations Analyst ... back-end billing functions and workflows, charge generation and capture, claims generation and reconciliation, remittance posting processes, retro adjudication and… more
- Molina Healthcare (Columbia, SC)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems ... * Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members.… more
- Access Dubuque (Dubuque, IA)
- …documentation, and other tasks involved with interfacing with MedOne's proprietary claims processing system. In addition, this position may assist teams across ... Support the PLAD team with implementation efforts, including plan-building activities in the claims system for new and existing clients. + Assist with testing plan… more
- Molina Healthcare (Seattle, WA)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems ... leadership based on feedback rom assigned MHI attorney. * Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting. * Advises… more
- Zelis (FL)
- …customizations and support testing and client "go-live". + Effectively partner with Edit Configuration and Claims Edit Validation Team to confirm client selected ... follows processes well. + Proactively partner with Client Policy Integration Director for input regarding Pre-Stakeholder meetings to validate pre-production data… more
- LogixHealth (Bedford, MA)
- …are implemented correctly. Communicating closely with the Contract Manager and Director . Key Responsibilities: + Analyze and model contracts to determine the ... projections + Review audits to ensure accurate contract implementation and subsequent claims processing + Obtain current contracted rates from clients and other… more