• Executive Director of R&D Global Quality…

    Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
    …being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These ... claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
    Otsuka America Pharmaceutical Inc. (08/14/25)
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  • Payment Integrity Subrogation Manager…

    Molina Healthcare (Albuquerque, NM)
    …in Medicaid, Medicare, and Marketplace lines of business. + Familiarity with QNXT claims processing platform. + Knowledge of legal procedures related to complex ... across a wide range of subrogation case types-including automobile-related claims (eg, no-fault/PIP), workers' compensation, general liability, medical malpractice,… more
    Molina Healthcare (07/23/25)
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  • Senior Analyst, Medical Economics - REMOTE

    Molina Healthcare (Roswell, NM)
    …of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing , etc.) + Knowledge of healthcare financial terms ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
    Molina Healthcare (07/10/25)
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  • Remote Licensed Property & Casualty…

    Mass Markets (NM)
    …736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, Customer Experience Provider (CXP), Customer ... MCI Federal Services (MFS), OnBrand24, The Sydney Call Center, Valor Intelligent Processing (VIP), BYC Aqua, EastWest BPO, TeleTechnology, and Vinculum. The purpose… more
    Mass Markets (07/08/25)
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  • Analyst, Business Quality ( Remote )

    Molina Healthcare (NM)
    …conducts research to resolve customer initiated issues related to core systems processing , and coordinates and manages project teams in the development of large ... + SQL expertise + Excel expertise + Medicare, Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting… more
    Molina Healthcare (08/10/25)
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  • Director, Enrollment (Duals) - REMOTE

    Molina Healthcare (NM)
    **Job Description** **Job Summary** Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's ... rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database.… more
    Molina Healthcare (08/08/25)
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  • Senior Analyst, Risk Adjustment - Predictive…

    Molina Healthcare (Rio Rancho, NM)
    …**Required Experience** + 3-5 Years of experience with healthcare-related data ( claims /encounters, provider, CMS/EDGE response files, etc. + 3-5 Years of experience ... of programming experience in python to support automated data validation / processing at scale (functions and objects) **PHYSICAL DEMANDS** Working environment is… more
    Molina Healthcare (08/03/25)
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  • Manager, Enrollment - REMOTE

    Molina Healthcare (Santa Fe, NM)
    **Job Description** **Job Summary** Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's ... rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database.… more
    Molina Healthcare (08/01/25)
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  • Mgr Medical Affairs - Clinical Development Sr…

    Canon USA & Affiliates (Santa Fe, NM)
    …and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business, ... protocol development, data acquisition, phantom studies, equipment evaluations, post processing , and development of presentations. + Provide evidence-based guidance… more
    Canon USA & Affiliates (08/19/25)
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  • Encounter Data Management Professional

    Humana (Santa Fe, NM)
    …team is seeking an Encounter Data Management Professional that has experience with business processing and data entry to join working remote anywhere in the US. ... problems within the encounter process between Humana and CMS using data analysis, claims research, and other resources to provide insight and ensure data integrity… more
    Humana (08/19/25)
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