- WTW (Miami, FL)
- **Description** We are seeking a highly motivated individual to join our Company as a Claims Analyst based in Miami. The candidate will have multiple claims ... such as supporting the effective management, analysis, and resolution of claims , ensuring accurate processing and timely communication between clients, reinsurers,… more
- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION **Job Summary** Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory ... with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** * Serves as … more
- Deloitte (Miami, FL)
- …work in a collaborative environment. As an experienced Epic Resolute Hospital Billing Analyst Project Delivery Specialist, you will have the ability to share new ... ideas and collaborate on projects without the extensive demands of travel. The Project Delivery Talent Model is designed for professionals with specialized skills that align to a current client need. Team members focus on delivering services to clients,… more
- Elevance Health (Miami, FL)
- **Title: Grievance/Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... employment, unless an accommodation is granted as required by law._ The **Grievance/Appeals Analyst I** is an entry level position in the Enterprise Grievance &… more
- Sedgwick (Miami, FL)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance SAP FICA Systems Analyst **PRIMARY PURPOSE OF THE ROLE:** To design and maintain robust, scalable ... INCLUDE** + Ensures software scalability and data integrity throughout all claims -related applications. + Ensures software compatibility and alignment with overall… more
- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION Job Summary Provides senior level analyst support for medical economics analysis activities, including extracting, analyzing and synthesizing data ... decision-making. * Mines and manages information from large data sources. * Analyzes claims and other data sources to identify early signs of trends or other… more
- Molina Healthcare (Miami, FL)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is… more
- ChenMed (Miami, FL)
- …expanding and we need great people to join our team. The Actuarial Services Analyst is responsible for managing and tracking the risk positions within ChenMed as ... business planning, process improvement, solution assessment, etc. + Analyzesand validatespayer claims data.Assistsmarkets to identify factors driving claims cost… more
- Sedgwick (Miami, FL)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Data Analyst Manager **PRIMARY PURPOSE OF THE ROLE:** To manage a staff of data ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- Sedgwick (Miami, FL)
- …in Financial Services & Insurance Workforce Analytics & Productivity Monitoring Analyst **PRIMARY PURPOSE OF THE ROLE:** To manage Sedgwick's Workforce Analytics ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- ChenMed (Miami, FL)
- …great people to join our team. Working with limited guidance, the Senior Analyst VBC (Value Based Care) Performance is responsible for proactively tracking the risk ... planning, process improvement, solution assessment, etc. + Analyzes and validates payer claims data. Assists markets to identify factors driving claims cost… more
- Elevance Health (Miami, FL)
- **Cost of Care/Provider Contracting Data Analyst Senior** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and ... is granted as required by law. The **Cost of Care/Provider Contracting Data Analyst Senior** is responsible for providing analytical support to the Cost of Care… more
- Elevance Health (Miami, FL)
- **Cost of Care/Provider Contracting Data Analyst ** **Location** : This role requires associates to be in-office 1-2 days per week, fostering collaboration and ... is granted as required by law. The **Cost of Care/Provider Contracting Data Analyst ** is responsible for provides analytical support to the Cost of Care and/or… more
- Carnival Cruise Line (Miami, FL)
- The Analyst , Global Risk Management will provide essential support to the Risk Management team in delivering accurate data and effective solutions across Marine ... and supports financial instrument placements and renewals. Additionally, the Analyst contributes to strategic initiatives related to Cards and Alternative… more
- Elevance Health (Miami, FL)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit … more
- World Insurance Associates, LLC. (Miami, FL)
- …Overview World Insurance is seeking an experienced Employee Benefits Underwriting & Financial Analyst to join our Underwriting & Analytics team. In this role, you ... Market review analysis + Renewal rate and funding initial projections/modeling + Claims utilization review + Rate and contribution modeling + Benchmarking studies +… more
- Molina Healthcare (Miami, 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
- Molina Healthcare (Miami, FL)
- **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and ... affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable… more
- Molina Healthcare (Miami, FL)
- **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and ... affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable… more
- Molina Healthcare (Miami, FL)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in… more