- Amazon (Seattle, WA)
- …and International benefits. - Serve as a subject-matter expert on insurance renewals, healthcare trends, claims analysis , and industry benchmarks. - ... Implement metrics and processes to track and measure healthcare quality. - Design reports and dashboards to support...solutions and benefit programs. - Develop models and pricing analysis for medical outlier claims . - Review… more
- Penn Medicine (Philadelphia, PA)
- …is preferred. + Prior experience with Medicare claims is preferred. + Healthcare data analysis experience is preferred. **Required Skills and Abilities** + ... position will function to make significant contributions related to claims analysis . This individual will jointly report...Master's Degree (in a Relevant field) And 2+ years Healthcare data analysis experience is required. +… more
- Molina Healthcare (KY)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and contract data regarding network ... utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on… more
- Molina Healthcare (KY)
- **Knowledge/Skills/Abilities** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc. + Analysis ...of healthcare analytics, predictive modeling, etc. + Analysis and forecasting of trends in medical costs to… more
- Molina Healthcare (NM)
- …Candidate must be able to work during EST hours **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data ... assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc. + Analysis ...of healthcare analytics, predictive modeling, etc. + Analysis and forecasting of trends in medical costs to… more
- Molina Healthcare (MI)
- …of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + 1-3 years claims analysis experience + 5+ years medical claims ... of education and experience **PREFERRED EXPERIENCE:** + 1-3 years claims analysis + 6+ years medical ...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- CGI Technologies and Solutions, Inc. (Atlanta, GA)
- ** HealthCare Claims Intelligence Engineer** **Category:** Analytics and Emerging Digital Technologies **Main location:** United States, Georgia, Atlanta ... implementing, and improving Advance Analytics solution that aims to perform claims analysis , fraud detection, and overall operational efficiency. **Your… more
- Commonwealth Care Alliance (Boston, MA)
- …and report outcome results on edits implemented. * Utilize data to examine large claims data sets to provide analysis and reports on existing provider billing ... CCA- Claims Essential Duties & Responsibilities: * Develop enhanced,...job. Required Experience (must have): * 7+ years of Healthcare experience, specific to Medicare and Medicaid * 7+… more
- HCA Healthcare (Nashville, TN)
- …with the primary function to ensure examiner payment accuracy of all claims processing including analysis of support services fulfillment colleagues' workflow ... ? At Work from Home, you come first. HCA Healthcare has committed up to $300 million in programs...part of our team. **Job Summary and Qualifications** The Claims Auditor will serve as a Subject Matter Expert… more
- Henry Ford Health System (Troy, MI)
- …efficiency and customer experience. + Assist in the collection, organization, and analysis of healthcare -related data. Ensure data accuracy and integrity, ... with industry professionals, enabling you to develop valuable skills in the healthcare and insurance sector. In addition to helping your assigned department meet… more
- Molina Healthcare (WA)
- …**Job Summary** The Senior Business Analyst is responsible for supporting the claims processing teams by supplying regular, timely, and accurate reports. As the ... senior level team member, this role leads efforts to ensure the claims teams and other departments have access to quality claims data through processes which are… more
- Molina Healthcare (UT)
- …Interfaces with the customer in developing requirements for major complex claims testing projects within Medicare, Medicaid and Marketplace; prepares system test ... reviews, analyzes and estimates project test requests. * Performs research and analysis of customer initiated inquiries and requests, utilizing technical tools as… more
- Molina Healthcare (IA)
- …on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates ... with clients to modify or tailor existing analysis or reports to meet their specific needs. May...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Robert Half Accountemps (Sterling Heights, MI)
- …the healthcare benefits industry and will primarily be focused on disability claims analysis . The job function includes analysing and adjusting disability ... Description We are offering a short term contract employment opportunity for a Medical Claims Analyst in STERLING HEIGHTS, Michigan. This role is in… more
- Humana (Columbus, OH)
- …caring community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures accuracy for pharmacy ... point of sale transition adjudicated claims logic. The Senior Pharmacy Claims Operations...assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Claims Job Category: Claims Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11739 ... net required to achieve that purpose. Job Summary The Claims Supervisor works with the Claims Manager...Duties Continued Education Required Bachelor's Degree in Business or Healthcare Related Field In lieu of degree, equivalent education… more
- System One (Reston, VA)
- Job Title: Domain Architect - Healthcare Claims Location: Remote - EST/CST ONLY (onsite required once per quarter / 4 times per year ) Role Type: 12+ months ... optimization by introducing capabilities (inclusive of all functions) for their Healthcare Claims domain of responsibility utilizing in-depth knowledge and… more
- Zelis (Atlanta, GA)
- …responsibilities as assigned Education Bachelor's Degree preferred Skills 3-5 years of claims experience in a healthcare environment Zelis is modernizing the ... The Regulated Claims Settlement Coordinator supports the Claims ...to calculate an offer + Drafts brief to provide analysis dispute along with objections to support client positions… more
- The Cigna Group (Bloomfield, CT)
- …with all MS office products including PowerPoint - REQUIRED + 5+ years of healthcare claims life cycle experience, emphasis in claims system requirements ... of business within The Cigna Group, is hiring a Claims System Configuration Lead Analyst. This **highly technical systems**...Matter Expert (SME) for the Configuration of the eviCore Claims Systems and the suite of eviCore Claim Products.… more
- The Cigna Group (Bloomfield, CT)
- …+ 5+ years of healthcare claims lifecycle; configuration design, editing, claims system requirements, and analysis required + 3+ years of experience in ... EviCore, a line of business within The Cigna Group is hiring a Claims Systems Configuration Quality Review Senior Analyst. For this **highly technical senior… more