- Molina Healthcare (Orlando, FL)
- …cause and resolve outstanding issues. Creates reports and analysis based on business needs and required or available data elements. Collaborates with Health Plans ... is a general role in which employees work with multiple types of business data. Will work cross functionally across multiple business areas.… more
- Healthfirst (FL)
- …+ Assist in the on-going evaluation of configuration for new and existing claims business rules including member benefits, claims editing, reference ... requirements and provide feedback to stakeholders regarding feasibility of claims business rule and program changes. +...understand manner to other staff. As the SME, the Claims Configuration Analyst will need to effectively… more
- Ford Motor Company (Tallahassee, FL)
- ** Claims Lead Analyst ** We are the movers of the world and the makers of the future. We get up every day, roll up our sleeves and build a better world -- ... is a hybrid role.** **What you'll do ** Lead development efforts for claims /returns modernization, ensuring current and future business requirements are met with… more
- Healthfirst (FL)
- …systems enhancements. + Follow the annual product development processes to manage major claims configuration projects, including claims business rule set up ... projects related to the development and configuration of new business , member benefits and products, claims editing,...of new business , member benefits and products, claims editing, reference data and their enhancements including … more
- Acosta Group (Tampa, FL)
- **DESCRIPTION** This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be ... responsible for analyzing claims and making decisions about their validity. The position...position will be a communicator to internal and external business partners and a problem solver/agent for change to… more
- Acosta Group (Tampa, FL)
- **DESCRIPTION** This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be ... responsible for analyzing claims and making decisions about their validity. The position...position will be a communicator to internal and external business partners and a problem solver/agent for change to… more
- Molina Healthcare (Jacksonville, 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 (FL)
- …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
- Centene Corporation (Tallahassee, FL)
- …or 3+ years of managed care encounters experience. Experience with encounters or claims business analysis experience in healthcare, preferably managed care or ... business process analysis, preferably in healthcare (ie documenting business process, gathering requirements) or claims payment/analysis experience.… more
- Molina Healthcare (Jacksonville, FL)
- …**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
- Robert Half Accountemps (Miami, FL)
- Description We are in search of a Business Analyst to join our team located in Miami, Florida. As part of our team, the Business Analyst will be ... CRM, Gap Analysis, Microsoft Excel, Microsoft Word, AB Testing, Agile Scrum, Business Process Functions, Business Requirement Document, and Claim Administration… more
- NextEra Energy (Palm Beach Gardens, FL)
- **PGD Business Analyst I** **Date:** Jan 14, 2025 **Location(s):** Palm Beach Gardens, FL, US, 33410 **Company:** NextEra Energy **Requisition ID:** 84971 is the ... will be involved in the following: + Budget/Forecasting and analysis + Insurance Claims - Cost Tracking + Generation Repair Services (GRS) - Cost Tracking +… more
- Elevance Health (Miami, FL)
- …and summarizes performance using summary statistical procedures. + Develops and analyzes business performance reports (eg for claims data, provider data, ... PulsePoint sites used for collaboration, community, and connection The **HEDIS Research Analyst ** is responsible for serving as an expert in HEDIS data analysis,… more
- AdventHealth (Altamonte Springs, FL)
- …identifying and sharing insights that improve operational, clinical, and financial performance. The Analyst will use healthcare data ( claims , labs, MMR data, EHR ... **Senior Medicare Data & Finance Analyst ** **Location:** Virtual **All the benefits and perks...role will include leveraging data from electronic health records, claims , and payer reports by means of SQL queries,… more
- Prime Therapeutics (Tallahassee, FL)
- …our passion and drives every decision we make. **Job Posting Title** Pricing Analyst - Remote **Job Description** The Pricing Analyst maintains, provides ... with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness &… more
- Sumitomo Pharma (Tallahassee, FL)
- …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
- ChenMed (Miami, FL)
- …we need great people to join our team. The Senior Health Economics Analyst is responsible for identifying and delivering data-driven insights and analytical support ... through the ability to leverage data and analytic skills to create business intelligence-identifying risks to be mitigated or opportunities to be seized. The… more
- Prime Therapeutics (Tallahassee, FL)
- …passion and drives every decision we make. **Job Posting Title** Sr. Pricing Analyst - Pharmacy Network - Remote **Job Description** The Senior Pricing Analyst ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more
- Molina Healthcare (FL)
- **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
- Prime Therapeutics (Tallahassee, FL)
- …Applied Analytics Analyst - Remote **Job Description** The Applied Analytics Analyst will provide business analytics for New Product Development, Product/ ... Benefit Plan Analysis. This position will support the process of combining business knowledge and quantitative analysis to identify business value opportunities… more