- Molina Healthcare (Las Cruces, NM)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network… more
- Molina Healthcare (San Diego, CA)
- **JOB DESCRIPTION** **Job Summary** The Analyst , Risk and Quality Reporting role supports Molina's Risk and Quality Health Plan team. This position designs and ... plan reports related to managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates + Assists and...for the assigned state + Work in an agile business environment to derive meaningful information out of organizational… more
- AdventHealth (Altamonte Springs, FL)
- …we are even better. **Shift** : Monday- Friday **Job Location** : Remote **The role you will contribute:** Responsible for denials prevention, root cause ... documentation. + Reviews managed care contracts and compares them against patient claims to identify and prevent claim underpayments. + Provides feedback to managed… more
- Molina Healthcare (Buffalo, NY)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network… more
- Molina Healthcare (NE)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network… more
- CareFirst (Baltimore, MD)
- …used for configuration in benefits & pricing for claims processing, claims editing configuration set-up and maintenance. Analyzes business requirements and ... Assesses alternatives to different designs and chooses best solution to fit business needs. Performs complex data modeling and database design with minimal… more
- NTT DATA North America (Oklahoma City, OK)
- …organization, apply now. We are currently seeking a HC and Insurance Operations Analyst to join our team. **Posisition:** ** Claims Case Manager** **This position ... monitors all technical issues and agent downtime. Consistent availability is critical to business operations. 2. Remote employees must adhere to all technical… more
- Medical Mutual of Ohio (OH)
- … remote opportunity. Eastern Time Zones preferred.** **Responsibilities** **HEDIS Analyst II** + Coordinates and collaborates interdepartmentally to produce the ... and Information Set (HEDIS) lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit… more
- Highmark Health (Lansing, MI)
- …+ Bachelor's Degree **EXPERIENCE** **Required** + 3 - 5 years of experience in a Business Analyst or Business Process Analyst role or experience ... significant amounts of information and analyzes processes to support business unit needs. May troubleshoot errors, conduct impact analyses,...within our Risk Adjustment team - it is a remote based role - looking for someone who has… more
- Commonwealth Care Alliance (Boston, MA)
- …of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective ... 011250 CCA- Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will… more