- Leprino Foods (Waverly, NY)
- The Human Resources Clerk VII ( Senior HR Administrator) provides complex administrative, project, and day-to-day functional support to the Human Resources Department ... distribution of paperwork, tracking status and time, along with progress of claims , and ensuring proper documentation is received. + Administers the Educational… more
- Northwell Health (New Hyde Park, NY)
- …modifiers. + Knowledge National Correct Coding Initiative (NCCI) edits and their impact on claims + Ability to analyze large datasets (eg, claims data, denial ... trends) to identify patterns, root causes of errors, and areas of revenue leakage or opportunity. + Proficiency in using tools like Excel for data manipulation and analysis. Additional Salary Detail** The salary range and/or hourly rate listed is a good faith… more
- CVS Health (Amherst, NY)
- …challenging role provides exposure to virtually all aspects of healthcare claims administration, from reinsurance/stop loss, data analytics, provider and broker ... loss carrier. **Required Qualifications** *Minimum of 1 year of experience in healthcare claims processing *Minimum of 2 years of experience with the suite of… more
- MetLife (New York, NY)
- …Key Responsibilities * Date science in Dental: Contributions to underwriting models, claims auto-adjudication logic and models, fraud waste and abuse analyses and ... models (mostly provider-related), dental network analyses, consumer analytics, network expansion analytics and much more. * Leads and contributes to data analysis and modeling projects from project/sample design, business review meetings with internal and… more
- Centene Corporation (New York, NY)
- …to providers that would improve utilization and health care quality. + Review claims involving complex, controversial, or unusual or new services in order to ... determine medical necessity and appropriate payment. + May develop alliances with the provider community through the development and implementation of the medical management programs. + As needed, may represent the business unit before various publics both… more
- AIG (New York, NY)
- …American Commercial, and Specialty portfolios. + Work closely with actuarial, claims , and other functions, integrating catastrophe modelling insights into day-to-day ... business, and portfolio optimization strategies. + Carry out other modelling business activities including event response, business planning, budgeting, profit studies, portfolio optimization, reinsurance purchasing, and other exercises where catastrophe risk… more
- Molina Healthcare (Yonkers, NY)
- …Perform research and analysis of complex healthcare utilization and performance date, claims data, pharmacy data, and lab data regarding utilization and cost ... containment information. + Evaluate, write, and present healthcare utilization and cost containment reports and makes recommendations based on relevant findings. + Oversee development, organization, and ongoing maintenance of data representing a wide range of… 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 ... to support ongoing reporting and analytics workflows. + Utilize Databricks and Snowflake to develop scalable data pipelines and analytical datasets. + Create and maintain Power BI dashboards to deliver insights on utilization, outcomes, and cost drivers across… more
- CVS Health (Albany, NY)
- …compliance impacting plan sponsors. + Collaborate with internal departments-including claims , customer service, and client management-to ensure effective issue ... resolution and maintain strong working relationships. + Stay informed about industry trends, regulatory changes, and best practices related to self-funded plans. **Required Qualifications** + A minimum of 7 years of relevant experience in a TPA (Third Party… more
- Western Digital (Albany, NY)
- …business models + Familiarity with legal guidance for marketing related claims and/or product liability matters + Knowledge of product regulatory matters ... related to hardware or software products SKILLS + Strong proficiency in drafting contracts or writing persuasively for a third-party audience + Attentively listens to others and encourages the open expression of diverse ideas and opinions + Provides timely and… more