- Molina Healthcare (Orlando, FL)
- **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
- Molina Healthcare (Orlando, FL)
- …**KNOWLEDGE/SKILLS/ABILITIES** + Provides research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit ... preferred + Assists with reducing re-work by identifying and remediating claims processing issues + Interprets, communicates, and presents, clear in-depth analysis… more
- Molina Healthcare (Orlando, FL)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... plans. + Must have experience in research, review and audits for adjudication rates of claims + Must be able to work in cross functional teams + Must have experience… more
- AdventHealth (Maitland, FL)
- …(Altamonte Springs,FL)** **The role you'll contribute:** A Senior Medical Economics analyst is responsible for analyzing and evaluating financial and economic data ... analyze fee schedules, and determine contract compliance. The Senior Medical Economics analyst must have attention to detail and competencies in decision support and… more
- Molina Healthcare (Orlando, FL)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key ... decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources (eg authorization) to identify early signs of trends… more
- Molina Healthcare (Orlando, FL)
- …organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, and external data to derive proper courses ... and existing health plans. + Completes analysis on retroactive claims reports + Pre and post validation of complex...Requires assistance with schema from Tech resource or Lead Analyst . + Writes Requirements for BRDs/FRDs and Reports. +… more
- MyFlorida (Orlando, FL)
- Systems Project Analyst - 79010063 Date: Jan 16, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 844950 Agency: Business and Professional Regulations Working Title: Systems Project Analyst - 79010063 Pay Plan: Career Service Position Number: 79010063 Salary:… more
- AssistRx (Orlando, FL)
- The Data Quality Analyst is responsible for acquiring, managing and analyzing data that will be presented to internal teams, clients and partners. The Data ... Analyst leads the onboarding of electronic data trading partners...issues. Successful applicants will have experience with Excel Pharmacy Claims experience is a huge plus Requirements + Developing… more
- AdventHealth (Altamonte Springs, FL)
- …- Onsite- Altamonte Springs, FL** **The role you'll contribute:** The Financial Analyst position is part of the Finance team and specifically will support ... the financial modeling and actuarial functions of the team. The Financial Analyst will assist the financial modeling and actuarial team with updating, reviewing, and… more
- Molina Healthcare (Orlando, FL)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... completion dates with Health Plans. + Must have experience with Benefits configuration, claims + The team is responsible for implementation and configuration of all… more
- Sedgwick (Orlando, FL)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Financial Analyst **PRIMARY PURPOSE:** To assist in financial planning, analysis and reporting ... their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more… more
- Molina Healthcare (Orlando, FL)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS… more
- Sedgwick (Orlando, FL)
- …Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Workforce Planning Analyst **PRIMARY PURPOSE:** To provide workforce development strategies and ... their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more… more
- Molina Healthcare (Orlando, FL)
- …and Provider data. + Experience working Marketplace, Medicaid, MMP - duals, specifically claims data + Experience conducting data analysis and data mining using SQL, ... Excel. **JOB QUALIFICATIONS** **Required Education** Associate degree or equivalent combination of education and experience **Required Experience** 1-3 years **Preferred Education** Bachelor's Degree or equivalent combination of education and experience… more
- Molina Healthcare (Orlando, FL)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. **KNOWLEDGE/SKILLS/ABILITIES** + Develops, implements, and uses software and systems to… more
- Molina Healthcare (Orlando, FL)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. **KNOWLEDGE/SKILLS/ABILITIES** + Develop ad-hoc reports using SQL programming, SQL Server… more
- Molina Healthcare (Orlando, FL)
- …operational processes including but not limited to Enrollment, UM, Claims & Care Management** **Preferred License, Certification, Association** Certified Business ... Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare… more
- Molina Healthcare (Orlando, FL)
- …opportunities to support clinical savings initiatives. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze claims and authorization data to identify trends or other issues ... related to medical care costs + Work closely with Marketplace and Behavioral Health teams to address emerging trends + Draw actionable conclusions based on analyses performed + Create impactful exhibits and data visualizations to illustrate key trend drivers +… more
- Molina Healthcare (Orlando, FL)
- …to support the departments goals. + SQL, Databricks, Python + Claims knowledge/QNXT **JOB QUALIFICATIONS** **Required Education** Associate's Degree or equivalent ... combination of education and experience **Required Experience** 1-3 years **Preferred Education** Bachelor's Degree or equivalent combination of education and experience **Preferred Experience** 3-5 years To all current Molina employees: If you are interested… more
- Abbott (Orlando, FL)
- …solutions are helping address some of the World's greatest healthcare challenges. As the Analyst I, QA, you'll have the chance to analyze and audit claims , ... auditing Insurance Verification, Billing, Collections, and Payment posting functions. + Review claims for insurance carriers and tracking the status of payments. +… more