- BlueCross BlueShield of North Carolina (NC)
- **Job Description** Are you an experienced actuarial professional with a passion for Medicare Advantage ? Join our dynamic team as a Senior Actuarial Analyst , ... degree or advanced degree (where required). + Minimum of 4 years of experience in Medicare Advantage . + Completion of at least 5 actuarial exams towards the ASA… more
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and running ... for claim encounter data submissions and the coordination of business transactions for all HIPPA/CMS standard sets. You will...more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5… more
- CVS Health (Harrisburg, PA)
- …track record leading or managing large projects + 6+ years of experience with Medicare Advantage products **Preferred Qualifications** + 6+ year of experience as ... Business Analytics you will be part of the Medicare Grievance Team, responsible for managing business ...Microsoft BI dashboards/reporting. + 8+ years of experience with Medicare Advantage products + Advanced Excel modeling… more
- Prime Therapeutics (Columbus, OH)
- …for a healthcare or PBM organization, or other highly regulated industry, including experience with Medicare Advantage and Medicare Part B + Must be eligible ... area of study, such as Juris Doctor + Implementation/Project management experience + Medicare Advantage / Medicare Part B **Physical Demands** + Ability to… more
- Zelis (TX)
- …and communicating rules, regulations, and procedures pertaining to public and private Medicare / Medicare Advantage payment systems. This position requires an ... Position Overview: The Medicare Regulatory Pricer Analyst will collaborate...Interact with regulators and clients to determine and document business requirements. + Lead pricer maintenance, quality assurance activities,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Medical Mutual' ... or related field. + 2 year's experience as a business analyst . Technical Skills and Knowledge: +...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and… more
- TEKsystems (Montgomery, AL)
- …that is configured to meet the business needs. This will require the Business Analyst to be very comfortable understanding the contract, the business , ... support this effort, the AMA is seeking an experienced Business Analyst to be a member of...years of experience in MMIS or domain knowledge of Medicare , Medicaid or with a major health care payer… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. **Responsibilities** ... Senior Employer Group Consulting Analyst Design and execute analyses and reports for clients...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- Amazon (San Francisco, CA)
- …will responsible primarily for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and ... Description Amazon One Medical is hiring a Actuarial Manager Analyst . Actuarial rigor is one of the keys to...compared to plan expectations. Key job responsibilities -Analysis of Medicare Advantage and Accountable Care Organization data… more
- AdventHealth (Maitland, FL)
- …appeal processes. * Facilitate resolution to contract violations by leveraging knowledge of Medicare Advantage plans regulatory requirements and Medicare ... Analyst will have expertise in Commercial and Governmental ( Medicare , Medicaid, Tricare) payer reimbursement language and methodologies. The Senior Compliance… more
- ChenMed (Miami, FL)
- …leadership and will make data-driven strategy recommendations in the Medicare Advantage and healthcare industry. This senior-level analyst position has the ... Minimum of four (4) years of related experience + Experience in a Medicare Advantage , Hospital Systems and/or risk-based healthcare organization, preferred We're… more
- UCLA Health (Los Angeles, CA)
- Description As a member of the Medicare Advantage Operations team, Business Data Analyst is instrumental in independently developing the detailed ... non-functional requirements are understood and implemented consistent with the Business Data Analyst 's vision + perform testing,...+ Minimum of five (5) years' experience in a Medicare or Managed Care environment managing enrollment, claims or… more
- Elevance Health (Atlanta, GA)
- …findings into understandable insights for various audiences. + Experience working with Medicare Advantage and knowledge of Risk Adjustment payment methodology is ... are seeking a dedicated and detail-oriented Risk Adjustment Reconciliation Analyst to join our team. The successful candidate will...They are how we achieve our strategy, power our business outcomes and drive our shared success - for… more
- ChenMed (Cincinnati, OH)
- …in data analytics, finance, or related field required. + Experience within the Medicare Advantage population strongly preferred. Experience working for a large, ... expanding and we need great people to join our team. Sales Enablement, Analyst position is responsible for identifying and executing opportunities to enhance the… more
- Harvard University (Cambridge, MA)
- …equity for older adults + Changing market dynamics of the growing Medicare Advantage program, including restrictiveness and accessibility of healthcare provider ... Statistician I Department Office Location:USA - MA - Boston Business Title:Statistical Analyst /ProgrammerSub-Unit: Salary Grade (https://hr.harvard.edu/salary-ranges#ranges) :056Time… more
- Molina Healthcare (Ventura, CA)
- …and industry codes affecting Managed Care, including but not limited to Medicare Advantage , Prescription Drug Plan, and Duals businesses, including Centers ... for Medicare & Medicaid Services (CMS) and Department of Managed...leads and executes corrective action plans, and monitors the business operations to ensure compliance with all applicable laws,… more
- Novant Health (NC)
- …represent key components of Novant Health's strategic goals. The Senior Analyst , Population Performance reports to the Manager, Population Performance, and supports ... performance opportunity identification. + Maintain a working knowledge of Medicare , Medicaid, and commercial insurance products and value-based care incentive… more
- Highmark Health (Columbus, OH)
- …This role develops and implements strategies to enhance member satisfaction for Medicare Advantage and Dual-Special Needs Plan members. Responsibilities include: ... analytical/strategic-thinking and leadership support that enables project teams to: 1) isolate business issues; 2) help design and execute analytics for studying … more
- CommonSpirit Health (Phoenix, AZ)
- …an understanding of the key elements of a payer contracts (commercial, Medicare advantage , Medicaid HMO), including reimbursement requirements. + Reviews ... that involve multiple department participation **Qualifications** + Associate's degree in Business Administration or relatedfieldand five years of experience in a… more
- The Health Management Academy (Arlington, VA)
- …and demographic metrics over time (eg, percent of revenue tied to Medicare Advantage ). Analysts are primarily responsible for conducting quantitative and ... a research setting, or graduate degree in healthcare administration, health policy, business , or related field Interpersonal Skills & Attributes: + Ability to work… more
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