- Somatus (Mclean, VA)
- …Analytics to create impact among Somatus' clients and leadership by analyzing Somatus' healthcare claims and care management data. This position will work ... grow, and be the best version of themselves, including: + Subsidized, personal healthcare coverage (medical, dental vision) + Flexible Paid Time Off (PTO) + 401(k)… more
- JS Perkins Consulting (Falls Church, VA)
- …Here is the Role: JS Perkins Consulting (JSPC) is seeking to hire a Budget Analyst to support the Defense Health Agency (DHA) Office of General Counsel (OGC) in its ... improve financial oversight and increase collections through the Medical Affirmative Claims (MAC) and Third-Party Collections (TPC) programs. This role will provide… more
- Cognizant (Washington, DC)
- 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
- Prime Therapeutics (Washington, DC)
- …every decision we make. **Job Posting Title** Specialty & Home Delivery Program Claims Analyst - Remote **Job Description** The Specialty & Home Delivery Program ... Claims Analyst is responsible for serving as...processing or project lifecycle, or related roles in the healthcare or PBM industry + Must be eligible to… more
- Evolent (Washington, DC)
- …**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
- Prime Therapeutics (Washington, DC)
- …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
- Evolent (Washington, DC)
- … 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
- Prime Therapeutics (Washington, DC)
- …data consolidation and modeling + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + Experience ... and drives every decision we make. **Job Posting Title** Data and Reporting Analyst Assoc- REMOTE **Job Description** The Associate Data & Reporting Analyst … more
- Prime Therapeutics (Washington, DC)
- …Posting Title** QA Analyst PBM Implementation - Remote **Job Description** The Quality Assurance (QA) Analyst performs complex quality reviews and serves ... GED is required + 2 years of experience within Claims Processing, Audit, Quality or Pharmacy +...Licensed Practical Nurse certification if working in Medicare + Healthcare , audit, and/or reporting and metrics environment experience +… more
- Evolent (Washington, DC)
- …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
- CVS Health (Washington, DC)
- …service orientation and attention to detail. **Preferred Qualifications** + Background in healthcare or claims processing experience. + Experience with Aetna ... technical expertise with strong communication and problem-solving skills to deliver high- quality support and drive continuous improvement. + Respond promptly and… more
- Evolent (Washington, DC)
- …You Will Be Doing:** + **Strategic Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, ... monthly, quarterly, and annual client reporting. In addition to quality review and client Q & A reporting. +...areas of sensitivity + 2 years of Account Management healthcare experience To ensure a secure hiring process we… more
- Highmark Health (Washington, DC)
- …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
- The Cigna Group (Mclean, VA)
- …the office or visit Providers 3 days per week The **Provider Contracting Lead Analyst ** serves as an integral member of the Provider Contracting Team and reports to ... of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales… more
- Highmark Health (Washington, DC)
- …Java Developer, DB2, Cogno, PEGA, Enterprise Architect(SCEA), Project Management, Certified Quality Analyst (CQA), Scrum Master Certification, Lean/Six Sigma ... complex applications that meet the service levels, system availability, performance and quality levels required by their customers. May mentor less experienced team… more
- Prime Therapeutics (Washington, DC)
- …information from research sources including the internet, trade publications, periodicals, analyst presentations, SEC filings, etc. + Support development of analytic ... 5 years of work experience in strategy, research or healthcare + Must be eligible to work in the...simultaneously **Preferred Qualifications** + Experience with large sets of claims data + In-depth knowledge of PBM industry +… more
- Norstella (Washington, DC)
- …manage a multi‑region product team and partner closely with Engineering, Content/ Analyst teams, Data Science, and Go‑to‑Market to deliver best‑in‑class forecasting, ... Integration** + Partner with Engineering and Data Science to incorporate RWD ( claims , lab, EMR) where it improves forecast accuracy and scenario planning. Champion… more
