- Molina Healthcare (Bowling Green, KY)
- …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 (Bowling Green, KY)
- **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 (Nashville, TN)
- …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 (Nashville, TN)
- …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 (Bowling Green, KY)
- …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 (Bowling Green, KY)
- …**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
- Elevance Health (Nashville, TN)
- ** Business Information Analyst II** **Location:** This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of ... one of our Elevance Health PulsePoint locations. The ** Business Information Analyst II** will be responsible...performance using summary statistical procedures. + Develops and analyzes business performance reports (eg for claims data,… more
- Bridgestone Americas (Nashville, TN)
- …as a "Bridgestone West" strategic region. This region services the strategic business needs of teams across the Americas, Europe, Middle East and Africa. ... understand the importance of seeing the world and our business through many different lenses. We are building a...Summary** We're currently looking for a Senior Workers Compensation Analyst to join our team. This role will be… more
- Prime Therapeutics (Nashville, TN)
- …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 (Nashville, TN)
- …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 (Nashville, TN)
- …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 (Bowling Green, KY)
- **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 (Nashville, TN)
- …Reporting Analyst - Remote **Job Description** The Senior Data & Reporting Analyst is responsible for supporting the business in decision making and ... operations efforts by providing data, reporting and business intelligence services. This role is responsible for acting...experience + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data… more
- Molina Healthcare (Bowling Green, KY)
- **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
- Evolent (Nashville, TN)
- …creativity, accountability, and a growth mindset as we solve complex business problems. **Collaboration Opportunities:** The Senior Analyst , Client Analytics ... structures associated with Commercial, Medicare, and Medicaid lines of business . Healthcare claims : specifically, differences between institutional vs… more
- PRGX (Nashville, TN)
- About PRGX Global, Inc ABOUT PRGX We provide the business intelligence to unlock incremental value from data and expand impact across our clients' organizations for ... empowers clients in more than 30 countries with the business intelligence to recover $1.2 billion in annual cash... operations. + Finds, supports, and documents audit and claims operations. + Produces claims using appropriate… more
- e CancerCare (Nashville, TN)
- Job Purpose: Contract Analyst will be responsible for analytic support related to ION network and providers. Team member will work closely with the Managed Care ... materials for internal and external meetings. . Act as business liaison to assigned business unit meetings...from audits. . Work in underpayment tool to appeal claims and recoup underpaid claims not paid… more
- Molina Healthcare (Bowling Green, KY)
- …Description** Who you are : + You have proven experience as a QA Analyst within an Agile environment. + Experienced testing on-premise and cloud based ETL/BI ... You can prioritize. + You have experience with QNXT, claims processing , healthcare insurance and SQL + You...QA role within our Agile team is a Senior Analyst position dedicated to ensuring the highest quality standards… more
- Molina Healthcare (Bowling Green, KY)
- …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...+ Must have experience in system configuration. + Monitor claims , create , generate and analyze reports using Excel… more
- Regions Bank (Nashville, TN)
- …section of the system. **Job Description:** At Regions, the Fraud Strategy Analyst performs analysis and interpretation of fraud-based threats by gathering and ... key initiatives and new and existing products + Conducts business and process reviews to identify gaps or ineffective...Strong data and analytics capabilities + Experience with fraud claims from intake to final decision + Understanding of… more