- Molina Healthcare (Santa Fe, NM)
- …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
- Molina Healthcare (Santa Fe, NM)
- **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 (Santa Fe, NM)
- …Project and Grants Management + Assessments and Feasibility Studies Analyzes claims for accuracy, provides client support, documents inquiries, supervises staff, ... process improvements. **Duties and Responsibilities** + Analyzes and reviews claims for accuracy, completeness and eligibility. + Provides leadership, supervision… more
- Public Consulting Group (Santa Fe, NM)
- …Education + Recovery Services **Duties and Responsibilities** + Analyzes the development of claims assigned at each level of the adjudication process. + Outlines the ... sent with applications. + Monitors and gives direction to Claims Developer regarding specific tasks on claims ....and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do… more
- Molina Healthcare (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …**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
- Prime Therapeutics (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- **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
- Molina Healthcare (Santa Fe, NM)
- **JOB DESCRIPTION** **Job Summary** Analyzes complex business problems and issues using data from internal and external sources to provide insight to ... influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and… more
- Molina Healthcare (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- **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 (Santa Fe, NM)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality...overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex… more
- Evolent (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables ... departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods… more
- Molina Healthcare (Santa Fe, NM)
- …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
- Molina Healthcare (Santa Fe, NM)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive… more
- Molina Healthcare (Santa Fe, NM)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive… more