- Norstella (Springfield, IL)
- 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
- Highmark Health (Springfield, IL)
- … 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
- Highmark Health (Springfield, IL)
- …including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims , and Medical Policy. The person in this position must ... resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a...of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim… more
- Public Consulting Group (Springfield, IL)
- … claim issue research. Additional this position will assist in performing claims processing, medical record audits for all implemented agencies, and assist ... and denied claim research results, final remittance advice processing, and medical record reviews that will include discussion with internal management to ensure… more
- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- …so that others can too._ In this exciting role, as a Sr. Analyst within OAPI supply chain team, you will work cross-functionally across various departments ... + Transact and document inventory movements and reconciliations, return and claim approvals, and product destructions. + Manage inventory reporting and communicate… more
- CVS Health (Springfield, IL)
- …do it all with heart, each and every day. **Position Summary** The Senior Analyst , Account Management will serve as a fully dedicated advocate to senior employees ... Liaising with healthcare providers. + Submitting and tracking out-of-network claims . + Managing administrative processes such as pre-authorizations and… more
- Intermountain Health (Springfield, IL)
- **Job Description:** The RCO Revenue Integrity Analyst II is responsible for appropriate charge capture, assigned account, claim edits and/or charge edits for an ... + Audits and evaluates system automation by comparing the charge/ claim data to the clinical record. Leverages other system...certification through AAPC, AHIMA or HFMA, or other specialty medical coding group. + Experience in a role requiring… more
- Rocket Software (Springfield, IL)
- …BELIEVE in what they're doing!** **Job Description Summary:** The Senior Benefit Analyst is responsible for building and delivering both global and local benefit ... in line with the global total rewards philosophy. The Senior Benefits Analyst supports the design, administration, and analysis of Americas' and global benefit… more
- Humana (Springfield, IL)
- …and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the Pricer Business and System Support team ... it expands to accommodate the increased responsibilities. The Provider Hospital Reimbursement Analyst r will be primarily responsible for maintenance and support of… more
- Humana (Springfield, IL)
- …and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Cognizant (Springfield, IL)
- **Health Payer Business Analyst , Senior Consulting Manager** **About the Role:** As a Sr. Consulting Manager you will make an impact by driving client engagement, ... firms * Strong background in Healthcare industry, including health plans, claims , and provider operations * Project management and people management experience… more
- Cardinal Health (Springfield, IL)
- …data from multiple sources (eg, Salesforce, Trella Insights, Definitive Healthcare, claims feeds, internal CRM/ERP) to deliver clear, actionable insights that ... Ensure HIPAA/privacy safeguards and appropriate minimum necessary use of PHI/ claims . + Define and operationalize Reach (# of targeted...benefits and programs to support health and well-being. + Medical , dental and vision coverage + Paid time off… more
- Intermountain Health (Springfield, IL)
- …guidelines, documentation requirements, and reimbursement policies, as well as ensures claims meet medical necessity for procedures performed. **Essential ... providers for clarification or additional information when needed. + Submits coded claims to billing department or third-party payers in a timely manner. +… more
- CVS Health (Springfield, IL)
- …analysis to estimate future healthcare costs, revenue, and profitability. + Analyzes claims data to assess patterns, trends, and cost drivers and identifies ... opportunities for cost containment, fraud detection, and quality improvement in claims processing and reimbursement. + Assesses impacts of new risk-sharing… more
- CVS Health (Springfield, IL)
- …and security requirements. **Required Qualifications** + 1 year minimum of claims processing experience + Experience with system testing and post go-live ... to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and… more
- CVS Health (Springfield, IL)
- …insights and present findings to non-technical audiences. + 2+ years experience interpreting medical claim data + Advanced experience in SQL & Python coding ... We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a...investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate… more
- Highmark Health (Springfield, IL)
- …data. This position routinely utilizes data including, but not limited to: medical /surgical physician and institutional claims and encounters, clinical data, ... robust analytical and financial analysis capability for Highmark's pharmacy and medical benefit specialty drug management programs. Furthermore, the incumbent will… more
- Public Consulting Group (Springfield, IL)
- …Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost ... + Provides leadership, management, and direction to the Quality Assurance Analyst team. + Leads and manages department providing oversight on operations,… more