- WelbeHealth (Los Angeles, CA)
- …Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and ... accurate pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or company policies and procedures. **This is a… more
- Elkay (Milwaukee, WI)
- Freight Audit and Claims Analyst **_The Company_** Zurn Elkay Water Solutions Corporation is a thriving, values-driven company focused on doing the right ... the Zurn Elkay Water Solutions Corporation family! **Job Description** The Freight Audit and Claims Analyst reports to the Logistics Systems & Analytics… more
- AIG (Concord, CA)
- Senior Claims Analyst Join us as a...+ You will also contribute to continuous improvement in Claims by supporting Quality Assurance / Regional Audit ... Senior Claims Analyst to take on key... to take on key responsibilities within a world-class claims function. Make your mark in Claims ...world-class claims function. Make your mark in Claims Our Claims teams are the proven… more
- CVS Health (Cumberland, RI)
- …team environment* Experience negotiating with vendors and landlords to settle audit claims * Experience preforming Contract Compliance Audits EducationBachelor's ... Cumberland, RI office three days per week.** The Internal Audit Recovery Analyst will be a key...of opportunity for recovery dollars, documenting and creating recovery claims , and corresponding with business partners as needed for… more
- Eaton Corporation (Moon Township, PA)
- Eaton's North American Sales division is currently seeking an Audit Analyst to join our team. This position is located in Moon Township, PA. This a great ... be responsible for the review of distributor rebates, pricing and return claims according to selling policy 25-000 guidelines. Auditing the authenticity of rebates… more
- Equitable (Charlotte, NC)
- Special Claims Analyst ( 240000E6 ) **Primary Location** : UNITED STATES-NC-Charlotte **Organization** : Equitable **Schedule** : Full-time **Description** At ... will help unlock your potential? Responsibilities of the Special Claims Analyst include: + Responsible for the...in our administrative systems. + Prepares monthly reports for audit and bookkeeping. + Performs other duties as required.… more
- CVS Health (Scottsdale, AZ)
- …more personal, convenient and affordable. Position Summary The Pharmacy Quality Control Analyst position is responsible for the timely and accurate delivery of key ... deliverables. The primary areas of responsibility include standards conformance, audit sampling, and regulatory compliance support. This position is accountable… more
- AmeriHealth Caritas (Manchester, NH)
- **Provider Network Operations Claims Analyst Sr (hybrid)** Location: Manchester, NH Primary Job Function: Provider Network ID**: 34151 **Job Brief** The Provider ... Network Operations Data Analyst Sr. will be responsible for supporting Provider Enrollment...This role is responsible for: + UAT/Client Review & audit (fee schedule concentration) - reviews requests prior to… more
- Amazon (Arlington, VA)
- …Global Risk Management and Claims team is seeking a Sr. Risk Analyst to assist with the development and management of Amazon's global insurance programs, ... techniques for new and existing business initiatives. Additionally, the Sr. Risk Analyst will manage the insurance programs for some Amazon owned subsidiaries. The… more
- The Cigna Group (Bloomfield, CT)
- …Guideline updates and policy determinations, as needed. Education & Experience The Quality Review & Audit Analyst will have a high school diploma and at least 2 ... The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical...(RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of… more
- Elevance Health (Denver, CO)
- …which would provide an equivalent background. **Preferred Qualifications:** + Pharmacy Claims Audit Strongly preferred + PBM (Pharmacy Benefit Management) ... for handling high level pharmaceutical claim audits and reviewing claims issues from junior team to ensure claims... claims issues from junior team to ensure claims are being resolved and reported in a timely… more
- CVS Health (Olympia, WA)
- …Utilize recruitment databases and contract management tools to design, build, load, audit , and edit complex contracts, agreements, amendments and fee schedules for ... accuracy + Compatible with a dynamic work environment + Working knowledge of medical claims and coding. Education High School Diploma or GED Required Pay Range The… more
- WellSense (Boston, MA)
- …claim files absorbed by the data warehouse on a monthly basis. . Works with Claims Operations Analyst to provide reports to assist with identification of claim ... Internal Controls/ Operational Financial Analyst WellSense Health Plan is a nonprofit health...issues. . Uses SAS and/or SQL coding to pull claims and membership data, has ability to join information… more
- The Hartford (Hartford, CT)
- …as we help shape the future. The Hartford is seeking to hire a Senior Litigation Analyst to join our Legal team. We are looking for motivated attorneys to join this ... office Legal Bill Review audits. As a Senior Litigation Analyst you will be expected to provide a breadth...determined. + Facilitate gathering and exchange of information with Claims regarding observed and identified billing issues. + Identify… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …clinical and operational excellence. **Primary Function/General Purpose of Position:** The Claims Analyst professional is responsible for coordinating activities ... Department and serves as liaison with internal customers and external entities. The Claims Analyst assists and supports System Directors and Managers responsible… more
- Arkansas Government Job (Little Rock, AR)
- …EOMB (Explanation of Medicare Benefits) and prepare for mailing . Assist with Audit 3383 Retrospective Review paid claims -Medicare Advantage Crossover Claims ... HEALTH CARE ANALYST Date: Jul 8, 2024 Req ID: 41347...agency policy governing health care. Knowledge of medical insurance claims procedures. Knowledge of medical terminology and records. Ability… more
- Tucson Electric Power (Tucson, AZ)
- **Risk Management Insurance Analyst I, II, or Senior** Company **Tucson Electric Power** Location **Tucson, AZ** Requisition ID **5674** **About Us** UNS Energy ... andhere (https://youtu.be/7BECywu-Re4) . **Job Description - Risk Management Insurance Analyst I, II, or Senior** **What you will do:** +… more
- State of Colorado (Denver, CO)
- Fraud Analyst - Remote/Hybrid Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4567772) Apply Fraud Analyst - Remote/Hybrid Salary ... Location Denver Metro, CO Job Type Full Time Job Number WAA00077-Fraud Analyst -07.24 Department Department of Treasury Opening Date 07/03/2024 Closing Date… more
- Baptist Memorial (Memphis, TN)
- …midstream and downstream revenue cycle activities that impact the adjustment processing of claims . + Conducts risk assessments to define audit priorities by ... to ensure that processes and practices lead to appropriate adjudication of claims . This role requires thorough understanding of regulatory requirements, managed care… more
- Portland General Electric (Tualatin, OR)
- … Analyst Intermediate/Advanced knowledge of risk management concepts including claims , insurance and loss prevention, credit analyses and security interests ... also affordable and accessible to all. **Summary/Job Function** The Settlements Analyst will be responsible for settling commodity transactions for various… more