- Amazon (Boston, MA)
- Description Amazon One Medical is hiring a Actuarial Manager Analyst . Actuarial rigor is one of the keys to our success. This candidate will responsible primarily ... for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and implement an actuarially sound… more
- Commonwealth Care Alliance (Boston, MA)
- …TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical ... This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for… more
- Elevance Health (Smithfield, RI)
- …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
- Prime Therapeutics (Boston, MA)
- …trend, benefit design and pricing support for all Prime's lines of business (commercial, Medicare and Medicaid). **Responsibilities** + Build, support , ... our passion and drives every decision we make. **Job Posting Title** Actuarial Analyst - REMOTE **Job Description** The Actuarial Analyst is responsible for… more
- Harvard University (Cambridge, MA)
- …I Department Office Location:USA - MA - Boston Business Title:Statistical Analyst /ProgrammerSub-Unit: Salary Grade (https://hr.harvard.edu/salary-ranges#ranges) ... and health services research projects. Our research team uses Medicare and other large national claims datasets to evaluate...of accrued vacation time per year (3 weeks for support staff and 4 weeks for administrative/professional staff), 12… more
- Prime Therapeutics (Boston, MA)
- …ensure the financial viability of all contract terms for both commercial and Medicare Part D business . **Responsibilities** + Assist the contract negotiators and ... every decision we make. **Job Posting Title** Trade Relations Analyst - Remote **Job Description** The Trade Relations ...facing documents + Perform miscellaneous reporting and analysis + Support the completion of RFP documents relating to the… more
- Prime Therapeutics (Boston, MA)
- …rebate and manufacturer admin fee forecasting, utilization management programs, and RFP's to support the business with critical evaluation on both strategic and ... and drives every decision we make. **Job Posting Title** Principal Trade Relations Analyst - Remote **Job Description** The Principal Trade Relations Analyst … more
- Prime Therapeutics (Boston, MA)
- …and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior Compliance ... Analyst assists in the implementation of Prime's compliance programs...to validate regulatory reporting requirements are met and that business operations are aligned with expectations of applicable regulatory… more
- Humana (Boston, MA)
- …community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be ... an integral part of the Pricer Business and System Support team responsible for...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- CVS Health (Woonsocket, RI)
- …heart, each and every day. **Position Summary** As a Healthcare Compliance Senior Analyst , you will ensure contractual and regulatory compliance as it relates to ... communications distributed by PBMs, processors, health plans, state Medicaid and Medicare , relative to prescription and/or medical claim processing + Serve as… more
- Humana (Boston, MA)
- …appropriate courses of action. **Job Description** The Medicaid Data and Reporting Analyst integrates data from multiple sources to produce requested or required ... data elements. This role will support our Medicaid Clinical operations in multiple markets. This...or resources. May create specifications for reports based on business requests. Understands department, segment, and organizational strategy and… more
- Highmark Health (Boston, MA)
- …external partners to design and execute member outreach and engagement programs to support Medicare CAHPS and the Health Outcomes Survey measures; developing ... and leadership support that enables project teams to: 1) isolate business issues; 2) help design and execute analytics for studying business … more
- Point32Health (Canton, MA)
- …and complex information into key insights. The individual will work effectively across business areas and often lead collaborative projects. They will need to follow ... complex business processes, consider options when problems arise, and identify...what you will be doing** **Data Submission Integrity** + Support the director across a range of activities, including… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …for providing data and reporting used to measure quality metrics in support of contracting strategies. This includes the development and maintenance of data ... and reporting programs used to support provider arrangements, including risk contracts such as the...Quality Contract (AQC) and expansion into other products/providers (PPO, Medicare , Small Group and Hospital). Key Accountabilities: + Provide… more