- Healthfirst (CO)
- … configuration recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and accurate claims payment. + Aid in ... easy to understand manner to other staff. As the SME, the Claims Configuration Analyst will need to effectively communicate with all levels of the organization,… more
- Commonwealth Care Alliance (Boston, MA)
- …specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication , clinical coding reviews for claims , settlement, ... Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims … more
- The Cigna Group (Bloomfield, CT)
- …Lives?** EviCore, a line of business within The Cigna Group, is hiring a Claims System Configuration Lead Analyst . This **highly technical systems** role acts as ... the Subject Matter Expert (SME) for the Configuration of the eviCore Claims Systems and the suite of eviCore Claim Products. You'll be the primary contact for… more
- Molina Healthcare (MI)
- …performance to ensure claims are processed accurately and timely + Identifies claims requiring reprocessing or re- adjudication in a timely manner to ensure ... **Job Description** **Job Summary** Serves as claims subject matter expert. Assist the business teams...subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages… more
- Chenega Corporation (San Antonio, TX)
- …Review Analyst ** is responsible for conducting reviews of disability claims competed by Medical and Psychological consultants and assisting with the initial ... onboarding and training of medical and psychological consultants. The Analyst identifies deficiencies in case work, documents the findings, cites to relevant policy,… more
- Kelsey-Seybold Clinic (TX)
- …to foster and sustain training program associated with Commercial and Medicare Advantage claims adjudication procedures, address the training needs for Claims ... is to provide training to newly hired and existing claims analyst . This position will also monitoring/provide... Claims Operation Experience with Facility and Professional Claims Adjudication Knowledge of Medicare Claims… more
- Kelsey-Seybold Clinic (Houston, TX)
- **Responsibilities** Responsible for the supervision of Commercial claims adjudication . Essential job functions include ensure that quality and productivity ... develop training and in-service initiatives. Oversee all quality improvement initiatives for Claims unit. Oversee the Provider Service Unit to ensure that service… more
- Allied Solutions (Plano, TX)
- …applicability of insurance coverage to certain claim types prior to the assignment to a Claims Adjuster or Analyst . The key responsibilities of this job are both ... and accurately to more senior level adjusting staff for adjudication and collection; + Adjudicate claims within the guidelines of the appropriate carrier on GAP… more
- ManpowerGroup (CA)
- …29-Mar-2025** **Target Pay: $50** ** ** **Primary Purpose** The Workers' Compensation Claims Analyst is responsible for analyzing complex or technically ... claims that may involve litigation and rehabilitation, ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …you will play a key part in ensuring the technology behind the full claims adjudication cycle is running smoothly, remains scalable, and is continuously enhanced ... growing. We have an exciting opportunity for a Programmer Analyst to join our technology team, focusing on benefits...changes + Troubleshoot errors during the load process and claims adjudication process communicating the outcome to… more
- CDPHP (Albany, NY)
- …support systems. QUALIFICATIONS: + Minimum three (3) years' experience that claims adjudication , progressive customer service, evaluation of business procedures ... to be a part of that experience. The Configuration Analyst II is responsible for leading the analysis, maintenance,...claims systems and any integrated systems. The Configuration Analyst II will recommend system and configuration solutions and… more
- Elevance Health (Norfolk, VA)
- …or billing credential required: CCS, CCS-P, CPC, CPB strongly preferred. + Experience in claims adjudication and application of NCCI editing and claims ... **Clinical Content Analyst ** **Location:** This position will work a hybrid...through review, testing and finally data validation. + Develops claims editing logic and content that promotes payment accuracy… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …you will play a key part in ensuring the technology behind the full claims adjudication cycle is running smoothly, remains scalable, and is continuously enhanced ... We have an exciting opportunity for a Jr. Programmer Analyst to join our technology team, focusing on benefits...outcome to appropriate stakeholders + Willingness to learn HealthCare Claims Adjudication system and process + Work… more
- AdventHealth (Maitland, FL)
- …app provider types + Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, CPT, HCPCS II, DRG ... (Altamonte Springs,FL)** **The role you'll contribute:** A Senior Medical Economics analyst is responsible for analyzing and evaluating financial and economic data… more
- CVS Health (Scottsdale, AZ)
- …is currently looking for a dynamic individual to join our team in an Sr. Analyst role. This is a client facing project management / auditor position that is ... by CMS / States. In this position, the Sr. Analyst will work closely with multiple clients and various...identified during the audit process, specifically related to pharmacy claims and manufacturer rebates. This includes having a working… more
- McLaren Health Care (Flint, MI)
- …customer and ad hoc reports. Responsible for routine maintenance of the claims adjudication system provider data, benefits, and pricing configuration. Assists ... We are looking for a Business Analyst I to join us in leading our...place of service, revenue and DRG codes in the claims adjudication system. **This position is fully… more
- ZF (Auburn Hills, MI)
- Quality Analyst II-Warranty Country/Region: US Location: Auburn Hills, MI, US, 48326 Req ID 75847 | Auburn Hills, United States ZF CV Systems North America LLC **Job ... SC or Lafayette, IN. **What you can look forward to as a Quality Analyst ** + Work effectively with customers using effective corrective action & adjudication … more
- Cybersecurity and Infrastructure Security Agency (Arlington, VA)
- …purpose of the position is to serve as the Management and Program Analyst with the National Risk Management Center (NRMC), Budget, Performance and Requirements ... be met by the closing date of this announcement. Qualification AND Time-in-Grade claims will be subject to verification. Education For positions with an education… more
- Baptist Memorial (Memphis, TN)
- …app provider types. + Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, CPT, HCPCS II, DRG ... Summary The Medical Health Economics Analyst conducts and interprets complex healthcare data analysis,...knowledge of healthcare managed care contracts and healthcare administrative claims data. + Employs existing complex models and implements… more
- Reynolds & Reynolds (Naperville, IL)
- …+ Experienced with Power BI preferred + Experience with mechanical service contracts or claims adjudication is a plus Benefits: We strive to offer an environment ... Asset Management Data Analyst - Automotive Naperville, IL Full-Time Apply Here...In this role you will be responsible for reviewing claims to ensure accuracy and resolve discrepancies. You will… more