- Prime Therapeutics (Santa Fe, NM)
- …fuels our passion and drives every decision we make. **Job Posting Title** Lead Claims Processor, Government Programs **Job Description** Adjudicate or submit ... and adjustments as required. + Implementation and maintenance of claims processing programs and procedures + Verify...and administrative duties as required by business need. + Lead and implement positive changes with a high level… more
- Molina Healthcare (Roswell, NM)
- …test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as… more
- Molina Healthcare (NM)
- …test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Create succinct ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- Molina Healthcare (Rio Rancho, NM)
- …test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of… more
- Molina Healthcare (NM)
- **Job Description** **Job Summary** We are seeking a highly experienced Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims ... accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and validating Medicaid… more
- Molina Healthcare (Albuquerque, NM)
- …and tests assumptions through data, but leads with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... **Job Description** **Job Summary** Provides lead level support as a highly capable business...operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to… more
- Fluor (Santa Fe, NM)
- …with subject matter experts, including other government contractors for the purpose of processing and validation of claims , to include receiving reports or ... Team Support/Onsite Lead Contract Coordinator Job Overview **Location** **:** United...+ Fully support all deployed technical specialists and onsite claims review support/administration activities + Administration includes daily accountability,… more
- Guardian Life (Santa Fe, NM)
- ** Lead AI Innovation Lead - Data Science Lab** **Overview** Guardian is on a transformation journey to evolve into a modern, forward-thinking insurance company ... of pioneering research into practical, enterprise-wide solutions. In this role as Managing Lead Data Scientist for the DSL, you'll be entrusted with the crucial task… more
- Humana (Santa Fe, NM)
- …and processes + Solid understanding of healthcare operations, particularly around claims processing , enrollment, provider data management and clinical ... and help us put health first** The State Technology Lead understands departmental and IT organizational strategy and operating...transitioned smoothly to markets. + Works with the Test Lead to develop plans of action for testing new… more
- CenterWell (Santa Fe, NM)
- …+ Support new business implementations with a goal of ensuring all pharmacy claims are processing appropriately + Drive project development and support project ... a part of our caring community and help us put health first** The Lead - Medicaid Customer Success oversees strategy and operations for multiple Medicaid markets.… more