• Regulatory Claims Analyst

    TEKsystems (Dallas, TX)
    …of the servicer and/or client + Files respective investor/insurer initial and final claims based on the respective guidelines for allowable limits + Reviews MI claim ... and research curtailment reasons for potential rebuttal + Files Appeal or Supplemental Claims ensuring all allowable advances and interest are recovered from the MI… more
    TEKsystems (05/21/25)
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  • Lead Analyst , Configuration Information…

    Molina Healthcare (Austin, TX)
    …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting,… more
    Molina Healthcare (05/18/25)
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  • Senior Quality Analyst , Claims

    Providence (Renton, WA)
    …Directors and Officers, Employment Practices, Fiduciary, Property, Cyber, Managed Care, and Auto Claims . The Senior Quality Analyst assists the Claims ... and regulations pertaining to self-insured health care organizations. The Senior Quality Analyst is also responsible for maintaining a claims quality assurance… more
    Providence (05/09/25)
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  • Claims Analyst IV-Auto and GL

    AIG (Atlanta, GA)
    …AIG, we are reimagining the way we help customers to manage risk. Join us as a Claims Analyst IV to play your part in that transformation. It's an opportunity to ... efficiency. How you will create an impact The Casualty Claims Analyst IV within the Lexington and...investigation, damage evaluation and claim resolution in accordance to regulatory and company standards. + Conducts a thorough investigation… more
    AIG (05/03/25)
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  • Card Fraud Claims Analyst Sr

    UMB Bank (Kansas City, MO)
    **Duties & Responsibilities :** Open to hybrid or remote working schedule The Sr Card Fraud Claims Analyst will be a member of the UMB Card Operations team and ... will report directly to the Card Fraud Claims Manager. Responsibilities of this position will include supporting...to ensure compliance with Reg E and Reg Z regulatory requirements. Serving as back-up for working basic reconciliation… more
    UMB Bank (05/13/25)
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  • Sr Analyst , Legal Claims

    Lowe's (Mooresville, NC)
    **Your Impact** The primary purpose of this role is to serve as a high-risk claims analyst for the Legal department, handling high risks/high value cases and ... issues. The role will also serve as an escalation point for the Claims Management department to transfer cases that, through development, meet specific triggers,… more
    Lowe's (05/02/25)
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  • Senior Stop Loss Claims Analyst

    Highmark Health (Frankfort, KY)
    …medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information ... evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for… more
    Highmark Health (04/26/25)
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  • Claims Analyst

    CenterLight Health System (NY)
    JOB PURPOSE: The Claim Analyst will play a pivotal role in enhancing the efficiency and effectiveness of the claims department by evaluating and refining ... guidelines. This position requires a working knowledge of Government Programs medical claims payment system and configuration with strong focus on data review and… more
    CenterLight Health System (04/26/25)
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  • Analyst , Claims Research

    Molina Healthcare (Cleveland, OH)
    claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads ... claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual… more
    Molina Healthcare (05/16/25)
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  • Claims Implementation Analyst

    Healthfirst (NY)
    …terms, prepare fee schedules and accurately document file changes into the claims processing system + Research and identify published updates to payment ... methodologies, fee schedules and claims editing policies from Medicare, Medicaid, and third-party sources. + Responsible for the overall success of implementations… more
    Healthfirst (05/29/25)
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  • Claims Business Analyst - Remote

    Cognizant (Frankfort, KY)
    …IT organization and lead changes to such specifications (with senior business analyst oversight through peer reviews); Develop an informed knowledge of the business ... all regulations and requirements. **Essential Functions:** + 3+years Medicare/Medicaid regulatory healthcare experience + Knowledge of claim adjudication processes… more
    Cognizant (05/20/25)
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  • Regulatory Affairs Analyst

    Unilever (El Segundo, CA)
    …infinite supply of Liquid IV for extraordinary hydration. **About the role:** The Regulatory Affairs (RA) Analyst is responsible for ensuring compliance of raw ... product documentation, and finished product packaging with internal specifications and external regulatory requirements. The RA Analyst will work closely with… more
    Unilever (04/18/25)
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  • Regulatory Analyst 1

    University of Miami (Miami, FL)
    …of Miami/UHealth Department of SCCC has an exciting opportunity for a Full Time Remote Regulatory Analyst 1. CORE JOB SUMMARY: The SCCC department is seeking a ... Regulatory Analyst 1 that will be responsible...Regulatory Analyst 1 that will be responsible for conducting the...revised treatment matrix which will identify possible cancers from claims data. The RA1 will facilitate the process of… more
    University of Miami (04/05/25)
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  • Regulatory Analyst 1

    University of Miami (Miami, FL)
    …of Miami/UHealth Department of SCCC has an exciting opportunity for a Full Time Regulatory Analyst 1 to work remotely. CORE JOB SUMMARY The Regulatory ... and tests the revised treatment matrix to identify possible cancers from claims data. CORE JOB FUNCTIONS Analyzes regulatory requirements, identifies potential… more
    University of Miami (05/30/25)
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  • Sr Medicaid Reimbursement Regulatory

    Zelis (Plano, TX)
    …interests that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory Pricer ... an accurate and timely fashion. What you'll do: + Research and decipher regulatory sources such as legislative rules, state registers, waiver programs and bulletins… more
    Zelis (05/20/25)
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  • Risk Management Analyst (Non Clinical) - St…

    Trinity Health (Albany, NY)
    …Type:** Full time **Shift:** Day Shift **Description:** **TITLE** Risk Analyst /Specialist **DEPARTMENT:** Clinical Quality & Safety **REPORTS TO:** Risk Manager ... being faithful to who we say we are. **POSITION SUMMARY** The Risk Analyst is primarily responsible for supporting non-clinical risk management activities in both… more
    Trinity Health (03/19/25)
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  • Network Services Analyst I/II/III

    Excellus BlueCross BlueShield (Dewitt, NY)
    …area/out of network non-par claims . In the course of this work, the Analyst will be required to work closely with others to assemble and produce documentation ... with sound and ethical procedures, objectives and controls, a Network Services Analyst analyzes and evaluates the composition and characteristics of Health Plan… more
    Excellus BlueCross BlueShield (05/24/25)
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  • Claim Analyst IV (Lexington), Professional…

    AIG (Boston, MA)
    Join us as a Claims Analyst IV to take on key responsibilities within a world-class claims function. Make your mark in Claims As a Claim Analyst IV, ... be responsible for handling all aspects of multi-line, financial lines claims from inception through conclusion brought against insureds. The responsibilities for… more
    AIG (03/15/25)
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  • Sr. Business Systems Analyst

    Prime Therapeutics (Eagan, MN)
    …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization ... and drives every decision we make. **Job Posting Title** Sr. Business Systems Analyst **Job Description** The Sr. Business Systems Analyst (BSA) is responsible… more
    Prime Therapeutics (04/25/25)
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  • Payment Integrity: Reimbursement Policy Quality…

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …Strategy, the Payment Integrity Reimbursement Policy Quality Assurance (QA) Analyst is responsible for completing invoice and reconciliation claim audits ... Quality assurance audit reviews and core functions include reconciling vendor invoiced claims against finalized paid claims to identify and document payment… more
    Blue Cross Blue Shield of Massachusetts (05/11/25)
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