- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Senior Business Systems Consultant Location: Hybrid | Eagan, Minnesota Career Area: Information Technology ... of Minnesota ClearStone Solutions is seeking a Senior Business Systems Consultant to join our dynamic team. This strategic...IT development initiatives within the Pharmacy Benefits Manager (PBM) claims space. As a Senior Consultant, you will serve… more
- Molina Healthcare (Houston, TX)
- …all payment integrity (PI) solutions. * Independently leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial ... Analysis_ * Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. * Applies understanding of… more
- MAPFRE Insurance (Webster, MA)
- …Damage Department. In this role, you'll ensure exceptional customer service, accurate claims investigation, and timely settlements. You'll also play a key role in ... Service** + Supervise adjusters handling first- and third-party physical damage claims under personal and commercial auto policies. + Monitor staffing levels,… more
- Sedgwick (Memphis, TN)
- …equivalent combination of education and experience required. Experience in multi-line claims management processes and system requirements strongly preferred. ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance IT Systems Analyst Specialist Sr **PRIMARY PURPOSE OF THE ROLE:** To lead the business… more
- System One (Nashville, TN)
- …aftermarket teams for quality-related issues + Submit material or process non-conformance claims through the Quality Management System + Prepare and distribute ... complex customer inquiries through research and deep understanding of internal systems and processes + Escalate issues as needed, ensuring complete documentation… more
- BronxCare Health System (Bronx, NY)
- …with maintaining and furthering a positive public perception of BronxCare Health System and its employees. - Contributes to and participates in the ... collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement… more
- Guidehouse (Minneapolis, MN)
- …of assigned Medicare and third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials. ... include: + Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific...Unlikely Edits (MUE) + Medical Necessity edits + Other claim level edits as assigned + As needed, review… more
- Essentia Health (Brainerd, MN)
- …claims to payers with full and complete information to satisfy and facilitate the claim for payment. Produce accurate and timely claims in order to prevent ... for working assigned work queues within the patient accounting system and claim scrubber edits prior to...other regulatory changes affecting the billing of health insurance claims and making recommendations regarding billing and system… more
- System One (Dayton, OH)
- …Experience integrating Azure with enterprise insurance platforms + Familiarity with claims , enrollment, provider, or member-facing systems + Experience ... supporting hybrid environments and cloud governance models System One, and its subsidiaries including Joule, ALTA IT...work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner… more
- Mount Sinai Health System (New York, NY)
- …:** Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight ... ideal candidate will have had some experience working with health administrative/insurance claims data and other large datasets. Prior experience with the Department… more