- Lumen (Albany, NY)
- …Utilize Vector Databases and Knowledge Graphs to enhance AI applications in underwriting, claims processing , and customer engagement + Develop data pipelines for ... and automation of complex decision-making processes + Apply natural language processing (NLP) techniques to analyze and extract insights from unstructured data… more
- Six Flags (Corfu, NY)
- …administrative responsibilities for HRIS systems, including payroll, ATS, scheduling, unemployment claims processing and on-boarding processes , including ... to include, but not limited to, applicant tracking, paperwork processing , document/record retention, benefits administration and payroll. Ensures adequate and… more
- City of New York (New York, NY)
- …systems, employment and work engagement services, revenue-producing computer matches, claims processing systems, and personnel management systems. ITS/Enterprise ... systems development, data telecommunications, database administration, planning of data/information processing , user services, or area networks, at least 18 months… more
- CVS Health (Albany, NY)
- …Quality, CPHQ preferred. + Background in Managed Care. + Familiarity with claims processing workflows. + Experience with quality improvement, PIPs, ANE ... requirements. + Apply clinical criteria and policies to member/provider claims and coordinate clinical resolutions with MD support. **Performance Improvement… more
- CVS Health (Albany, NY)
- …levels + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing , Provider Appeals & Disputes and Network Performance ... well as for internal staff and aligns Network functions with Operations and Claims as needed. + Collaborates with internal partners to assess effectiveness of… more
- Capgemini (New York, NY)
- …Tableau or Qlik Strong understanding of insurance workflows such as policy issuance claims processing and customer onboarding Ability to work with large datasets ... workflows The analyst will support optimization initiatives for policy servicing claims management and customer engagement platforms Key Responsibilities Collect and… more
- Highmark Health (Albany, NY)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- EPAM Systems (New York, NY)
- …into E2E testing strategies + Develop and communicate test strategies covering pharmacy claims processing , NCPDP transactions, and benefit designs + Design test ... leading large, complex, cross-functional teams + Extensive knowledge of pharmacy claims adjudication, NCPDP protocols, formulary management, and benefit design +… more
- Molina Healthcare (Albany, NY)
- …Architectural compliance and governance. **Knowledge/Skills/Abilities** + Healthcare knowledge in Claims Processing and Payments + Develops software (hands ... Designs and develops SW applications or systems solving specific business or processing problem (Web or Mobile) + Gathers business requirements and develops… more
- Bowery Residents Committee (Manhattan, NY)
- …+ Highly proficient with Microsoft Office tools. + Prior knowledge of electronic claims processing would be preferred. *Vaccination preferred but not required. ... for accounts receivable processes and daily cash receipts. Accurate and timely processing of billings, receipts, and related payments. Perform analysis of assigned… more