- Usaa (Phoenix, AZ)
- …for determining settlement amounts outside of authority limits and accurately manages claims outcomes. Maintains accurate, thorough, and current claim file ... and framework to investigate, evaluate, negotiate, and settle complex property insurance claims presented by or against our members. You will confirm and analyzes… more
- Usaa (Seattle, WA)
- …guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance ... investigation strategies on any questionable or suspect first or third part claims . Participates in the development of fraud prevention strategies. Applies knowledge… more
- Harbor Health Services, Inc. (Mattapan, MA)
- …upon request of utilization or finance department. Works with UM RNs and Senior Medical Director to deny claims when appropriate. Attends IDT meetings on routine ... of quality measures and other data by the Quality Analyst for report to regulatory agencies, including CMS and...including UM/CM, Grievance and Appeals, inpatient and outpatient services, medical policy, and clinical claims review In-depth… more
- Norstella (Topeka, KS)
- Sr. Medical Analyst , RWD Company: MMIT Location: Remote, United States Date Posted: Nov 20, 2025 Employment Type: Full Time Job ID: R-1548 **Description** At ... to extract meaningful insights from **real-world data (RWD)** sources, including ** claims , laboratory results, billing codes, and electronic health records (EHRs)**… more
- Aston Carter (Salem, OR)
- Job Title: Medical Coding Analyst Job Description The Medical Coding Analyst plays a critical role in ensuring accurate medical coding and compliance ... Prior experience in initiating and leading performance improvement projects within a medical coding environment. + Understanding of EHR, Claims Adjudication… more
- Martin's Point Health Care (Portland, ME)
- …as a "Great Place to Work" since 2015. Position Summary The Senior Medical Economics Analyst - Pharmacy is responsible for performing advanced analytical ... pharmacy benefit design, formulary management, and value-based initiatives. The analyst partners closely with pharmacy, actuarial, clinical, and finance teams… more
- TEKsystems (Tampa, FL)
- …& Qualifications + Extensive understanding of the Revenue Cycle + Experience working as a Medical Claims Analyst + Experience and knowledge in Medical ... outreach, and refund resolution. The ideal candidate will have strong analytical skills, medical claims experience, and the ability to navigate complex systems… more
- Trinity Health (East Greenbush, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Revenue Cycle Analyst - Medical Group - East Greenbush, NY - FT** If you are looking for a ... remote 1 day a week. . This Revenue Cycle Analyst is needed for the medical group....outstanding claims to contact to ensure all claims are billed timely + Review each claim… more
- Amazon (New York, NY)
- …of actuarial reserving, forecasting and medical economics -Expertise in working with medical claims data and using programming languages such as SQL, R, SAS, ... Description Amazon One Medical is hiring a Actuarial Manager Analyst . Actuarial rigor is one of the keys to our success. This candidate will responsible… more
- BronxCare Health System (Bronx, NY)
- …collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement ... maintains confidentiality. - Coordinates filing of all necessary data into the medical record to insure compliance with AIDS Institute requirements. - Collects and… more
- Elevance Health (Tampa, FL)
- …not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... into effective and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management, CPT, HCPCS… more
- Centene Corporation (Jefferson City, MO)
- …clinical outcomes. + Interpret and analyze data from multiple sources including claims , provider, member, and encounters data. Identify and assess the business ... Microsoft PowerBI. Experience in emerging trend analysis, financial modeling, claims pricing, contract/network analysis, and/or ROI evaluation preferred. Familiarity… more
- Centene Corporation (Lansing, MI)
- …support for business operations in all or some of the following areas: claims , provider data, member data, clinical data, HEDIS, pharmacy, external reporting + ... visualization tools. Experience in emerging trend analysis, financial modeling, claims pricing, contract/network analysis, and/or ROI evaluation preferred. Familiarity… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …will be considered. * 3 years of relevant health plan or provider office medical coding/ claims and/or Business Analyst experience in a healthcare setting ... and Blue Shield of Minnesota Position Title: Healthcare Coding Analyst Location: Hybrid | Eagan, Minnesota Career Area: Customer...claims adjudication. This includes analysis of changes to medical code sets to determine impacts to and necessary… more
- Elevance Health (Atlanta, GA)
- …Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Business Analyst III** will be responsible ... **Business Analyst III - Payment Intergrity Datamining** **Location:** This...and Experiences:** + Comprehensive understanding of healthcare payer systems, claims processes, and coding practices preferred. + Demonstrated proficiency… more
- CVS Health (Tallahassee, FL)
- …The ** Claim Field Analyst ** works with the grievance and appeal and claims operations department to trend provider claim issues or concerns that could be ... with heart, each and every day. **Position Summary** The ** Claim Field Analyst ** acts as the primary...assigned. **Required Qualifications** + 3+ years of experience in medical billing and coding, specifically related to claims… more
- Principal Financial Group (Des Moines, IA)
- **What You'll Do** As a ** Claim Analyst 3** on our individual disability team, your day will be anything but routine. This is a small team with a collaborative ... and refer claims to other resources (senior claims personnel, Medical , Law, etc) with appropriate...medical conditions, restrictions & limitations, disability policy provisions, claim decisions, and all other aspects of the … more
- Travelers Insurance Company (St. Paul, MN)
- …issue accurate and timely indemnity, medical and expense payments for lifetime/long-term claims . + Determine Value of Claim . + Complete required letters and ... 2 **What Is the Opportunity?** Under moderate supervision, manage Workers' Compensation Claims with: Stable Lifetime Indemnity and/or Medical Benefits where the… more
- Highmark Health (Topeka, KS)
- … terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information ... claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim...years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Medicaid Claims Analyst Date: Dec 4, 2025...to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure ... to make a difference with. **The opportunity** The Medicaid Claims Analyst is responsible for Medicaid Drug...Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency.… more
