- Constructive Partnerships Unlimited (Manhattan, NY)
- …with management and program staff on the development of strategies, systems , policies/procedures, as appropriate to correct identified issues. + Attends trainings ... the code of business conduct, the NYS and federal false claims acts, whistleblower protections and mandatory reporting. Completes corporate compliance training… more
- Molina Healthcare (Buffalo, NY)
- …advanced SQL queries to extract, validate, and analyze healthcare data, including claims , pharmacy, and lab datasets. + Build and maintain efficient ETL pipelines ... Associate's degree in Data Science, Computer Science, Analytics, Information Systems , Engineering, or other technology-related fields **REQUIRED EXPERIENCE /… more
- Humana (Albany, NY)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... products, or other Medical management organizations, hospitals/ Integrated Delivery Systems , health insurance, other healthcare providers, clinical group practice… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …these domains for self-funded client implementation (Enrollment/Benefit Administration, Claims Administration, Portals, Finance, Reporting). + Strong leadership, ... Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems , providers as well as other TPAs, and enables them to solve… more
- Guardian Life (New York, NY)
- …to work closely with one of our core GB value streams (eg, underwriting, claims , distribution, etc.) to manage, define, shape, prioritize and lead the delivery and ... Delivery Lead will develop a keen understanding of value stream processes, supporting systems and key data elements. Moreover, the role will establish and nurture… more
- M&T Bank (Getzville, NY)
- …various loss mitigation opportunities, such as repayment plans, modifications, and partial claims , aiming to keep borrowers in their homes or manage property ... Excellent oral and written communication skills. + Strong knowledge of departmental systems , documents and procedures. **Working Model/Office Location:** + This is a… more
- Highmark Health (Albany, NY)
- …scope and complexity + 5 years with coding languages, analytical software, systems , tools and processes using claims , clinical, enrollment and provider ... data + 3 years of project leadership in a complex, matrixed environment (payer and/or provider preferred) + 3 years of providing analytical consultation to clinical, administrative, operational and financial stakeholders **Preferred** + None **LICENSES or… more
- MTA (Jamaica, NY)
- …fleet and more subway and commuter rail cars than all other US transit systems combined. MTA strives to provide a safe and reliable commute, excellent customer ... advice and support to various departments in the defense and resolution of claims arising under various agreements, including but not limited to the Penn Station… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …Perform benefit changes and updates for existing ProAct business in all appropriate systems . + Act as a leader for the Benefit Operations Specialist team., ... related field **Experience:** + Required: 1 year experience using the RxIQ claims adjudication platform + Preferred: 2 Years experience with Health Care, Insurance… more
- Molina Healthcare (NY)
- …team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data ... + Healthcare Analyst I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + Data modelling and BI tools To all current Molina… more