- Molina Healthcare (Detroit, MI)
- …Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to ... database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits,… more
- Molina Healthcare (Detroit, MI)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network… more
- Elevance Health (Dearborn, MI)
- **JR144681 Business Analyst III /Senior Tester** A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of ... live within 50 miles of one of our Elevance Health PulsePoint locations. The ** Business Analyst III/Senior Tester** will be responsible for serving as the… more
- Elevance Health (Dearborn, MI)
- ** Business Analyst ** A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of new technologies and a ... of one of our Elevance Health PulsePoint locations. The ** Business Analyst III** is responsible for serving...Analysis, Requirement gathering and execution and/or healthcare operations is required . + Exposure to PBM Claims Adjudication… more
- Elevance Health (Dearborn, MI)
- …a strong, clinical-first lens to deliver member-centered, lasting pharmacy care. The **Test Analyst ( Business Analyst III)** will be responsible for serving ... **Test Analyst - Pharmacy Benefit Management (PBM)** **Location:** Alternate...as the liaison between the business and IT in translating complex business … more
- Molina Healthcare (Detroit, MI)
- **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 to identify early signs… more
- Molina Healthcare (Detroit, MI)
- …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...methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule… more
- Molina Healthcare (Detroit, MI)
- …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...and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary. + Works with… more
- Molina Healthcare (Detroit, MI)
- …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 contracts and benefits configuration. + Strong background in claims is required . + Experience working on… more
- Molina Healthcare (Detroit, MI)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... organizations. + Maintains SharePoint Sites as needed. **JOB QUALIFICATIONS** ** Required Education** Bachelor's Degree in Finance, Economics, Computer Science **… more
- Molina Healthcare (Detroit, MI)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network… more
- Molina Healthcare (Detroit, MI)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... Analyzing Financial and Utilization Metrics of Healthcare. **JOB QUALIFICATIONS** ** Required Education** Bachelor's Degree in Finance, Economics, Computer Science **… more
- Molina Healthcare (Detroit, MI)
- …opportunities to support clinical savings initiatives. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze claims and authorization data to identify trends or other issues ... exhibits and data visualizations to illustrate key trend drivers + Work with business owners to track performance indicators of medical interventions + Extract and… more
- Elevance Health (Dearborn, MI)
- …and summarizes performance using summary statistical procedures. + Develops and analyzes business performance reports (eg for claims data, provider data, ... **HEDIS Business Information Consultant** **Location:** This position will take...days physically in office per week** . Associates are ** required ** to live within a 50-mile radius and a… more