- Molina Healthcare (Caldwell, ID)
- …root cause and resolve outstanding issues. Creates reports and analysis based on business needs and required or available data elements. Collaborates with Health ... remediation plans and fixes, overall progress, and status of impacted claims **JOB QUALIFICATIONS** ** Required Education** Associate's Degree or equivalent… more
- Molina Healthcare (Caldwell, ID)
- **Job Description** Job Summary Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are ... appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints,… more
- Public Consulting Group (Boise, ID)
- …operation of help desk lines. + Trains others on the function of analyzing claims . ** Required Skills** + Ability to evaluate, coordinate and perform a complex ... Project and Grants Management + Assessments and Feasibility Studies Analyzes claims for accuracy, provides client support, documents inquiries, supervises staff,… more
- Public Consulting Group (Boise, ID)
- …Education + Recovery Services **Duties and Responsibilities** + Analyzes the development of claims assigned at each level of the adjudication process. + Outlines the ... case summaries to be sent with applications. + Monitors and gives direction to Claims Developer regarding specific tasks on claims . + Provides monthly reporting… more
- Molina Healthcare (Caldwell, ID)
- …Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to ... to be housed on databases and ensure adherence to business and system requirements of customers as it pertains...in research, review and audits for adjudication rates of claims + Must be able to work in cross… more
- Molina Healthcare (Caldwell, ID)
- …**Job Summary** A successful candidate will have a balance of business insight, critical thinking, strong communication and analytical skills. Possess the ... organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, and external data to derive proper courses… more
- HomeSafe Alliance (Boise, ID)
- **Title:** Lead IT Business Process Analyst (Lead Product Owner) **_HomeSafe Alliance_** is the single global household goods movement manager of over 300,000 ... of field to ensure task completion in compliance with policies, procedures, and business strategy. Skills required for this job are typically acquired through… more
- Prime Therapeutics (Boise, ID)
- …flexible schedule which may include weekends, holidays, or shifts outside of Prime's core business hours of 9:00am-3:00pm + Constantly required to sit, use hands ... our passion and drives every decision we make. **Job Posting Title** Pricing Analyst - Remote **Job Description** The Pricing Analyst maintains, provides… more
- Sumitomo Pharma (Boise, ID)
- …and to clean up historical utilization that is routinely submitted with Medicaid claims . In addition, the analyst will load Medicaid claim information into ... dynamic, highly motivated, and experienced individual for the position of ** Analyst , Medicaid Rebates.** This individual contributor role is responsible for… more
- Prime Therapeutics (Boise, ID)
- …flexible schedule which may include weekends, holidays, or shifts outside of Prime's core business hours of 9:00am-3:00pm + Constantly required to sit, use hands ... every decision we make. **Job Posting Title** Sr. Pricing Analyst - Pharmacy Network - Remote **Job Description** The...revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other… more
- Molina Healthcare (Caldwell, ID)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key ... business issues related to cost, utilization and revenue for...and manage information from large data sources. + Analyze claims and other data sources (eg authorization) to identify… more
- Evolent (Boise, ID)
- …creativity, accountability, and a growth mindset as we solve complex business problems. **Collaboration Opportunities:** The Senior Analyst , Client Analytics ... reports with complex regulatory/clinical requirements for healthcare lines of business - ** Required ** + 2+ years of...SAS, SQL Programming Experience with large amounts of healthcare claims and authorization data - ** Required ** +… more
- Molina Healthcare (Caldwell, ID)
- …data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with ... Education** Bachelor's Degree or equivalent combination of education and experience ** Required Experience** + 5-7 years of business or experience system… more
- Molina Healthcare (Caldwell, ID)
- …Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to ... to be housed on databases and ensure adherence to business and system requirements of customers as it pertains...Health Plans. + Must have experience with Benefits configuration, claims + The team is responsible for implementation and… more
- HealthEdge Software Inc (Boise, ID)
- …root-cause issues are identified and addressed upstream, and all aspects of claims operations are centralized for comprehensive business intelligence. The ... implementing proprietary healthcare edits that drive cost savings and accuracy in claims processing. The successful candidate will be responsible for taking a senior… more
- Lumen (Boise, ID)
- **About Lumen** Lumen connects the world. We are igniting business growth by connecting people, data and applications - quickly, securely, and effortlessly. ... which serves as the nucleus for go-to-market strategies, the Product Marketing Analyst plays a crucial role in orchestrating the successful introduction and… more
- Molina Healthcare (Caldwell, ID)
- …data and vendor competencies. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with ... **Job Description** **Job Summary** Supports ongoing Claims and Enrollment operations in the management of...+ Must be able to lead meetings **Job Qualifications** ** REQUIRED EDUCATION:** Bachelor's degree in Business or… more
- Evolent (Boise, ID)
- …selves to work. That's one reason why diversity and inclusion are core to our business . Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ... Analytics team offers candidates the opportunity to work with key business , analytics, product, and operational leaders to deliver client-specific analytical… more
- Molina Healthcare (Caldwell, ID)
- …systems to support the departments goals. + SQL, Databricks, Python + Claims knowledge/QNXT **JOB QUALIFICATIONS** ** Required Education** Associate's Degree or ... used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables… more
- Molina Healthcare (Caldwell, ID)
- …analyses on a variety of topics related to the overall support of business operations. + Creates and maintains reports to manage claim inventory, adjustment ... findings and may develop recommendations to solve problems and issues related to business operations. + Follows team coding standards for report design. Works to… more