- Molina Healthcare (Madison, WI)
- …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
- Wolters Kluwer (Madison, WI)
- …Location:_** Riverwoods, IL (USA) **About the Role:** We are seeking a highly skilled Business Analyst to join the Mediregs team focusing on claims ... proficient in analyzing CMS rules as it relates to claims and processes. The candidate will be able to...contribute to software maintenance and final acceptance testing. The Business Analyst works closely with a cross-functional… more
- Prime Therapeutics (Madison, WI)
- …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization + ... fuels our passion and drives every decision we make. **Job Posting Title** Sr. IT Business Systems Analyst Remote **Job Description** The Business Systems … more
- Molina Healthcare (Madison, WI)
- **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 (Madison, WI)
- …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 (Madison, WI)
- …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
- Prime Therapeutics (Madison, WI)
- …It fuels our passion and drives every decision we make. **Job Posting Title** IT Business Systems Analyst - REMOTE **Job Description** The Business Systems ... and document the requirements and technical solutions for changes to Prime's claims systems. **Responsibilities** + Ensure understanding of business requirements… more
- Molina Healthcare (Madison, WI)
- …**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
- Sumitomo Pharma (Madison, WI)
- …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 (Madison, WI)
- …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 (Madison, WI)
- **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 (Madison, WI)
- …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
- Evolent (Madison, WI)
- …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:** ... **Job Posting: Senior Analyst , Performance Analytics** **Location: Remote** Evolent is seeking a..., Performance Suite Analytics to join our Performance Suite business unit. Our mission is to improve and innovate… more
- Molina Healthcare (Madison, WI)
- **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 (Madison, WI)
- …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
- Prime Therapeutics (Madison, WI)
- …Works independently to research and resolve regulatory inquiries/complaints related to claims , contracting and XXXX. Works directly with business partners ... and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Regulatory Complaints & Inquires) - Remote **Job Description** The Regulatory… more
- Prime Therapeutics (Madison, WI)
- …our passion and drives every decision we make. **Job Posting Title** Health Data Analyst Sr- REMOTE **Job Description** The Senior Health Data Analyst provides ... as a champion of the consulting and analytic methodology for designated line of business ; may provide work direction, serve as a mentor or train junior level… more
- Molina Healthcare (Madison, WI)
- …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 (Madison, WI)
- …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
- Molina Healthcare (Madison, WI)
- **Job Description** **Job Summary** The Sr Analyst , Risk Adjustment - Predicitve Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs ... and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and related financial data like risk...overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex… more