• Senior Software Engineer- COBOL coding

    Humana (Charleston, WV)
    …team at Humana is essential in delivering core services through effective claims processing and management solutions. This position involves coding software ... applications based on business requirements and addressing moderately complex to complex issues through in-depth analysis. **Responsibilities** + Code software applications that align with business requirements, ensuring high-quality standards. + Standardize… more
    Humana (10/16/25)
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  • Lead Analytics Consultant-Fraud Analytics

    Wells Fargo (Chandler, AZ)
    …processes including transaction decisioning, post-decision customer contact/analysis, and fraud claims processing + Support authorization systems / score ... actionable and tangible strategies Partner with Card Operations, Product, Fraud Claims , Compromise Management, and Strategy Implementation teams to understand and… more
    Wells Fargo (10/16/25)
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  • Business Analyst III - Carelon Payment Integrity

    Elevance Health (Roanoke, VA)
    …**Preferred Skills, Capabilities and Experiences:** + Prior experience in health insurance claims processing (eg, coding, keying, adjusting) highly preferred. + ... drive real savings. This position plays a critical role in uncovering claims overpayments and guiding clients through implementation of data-driven insights. This… more
    Elevance Health (10/16/25)
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  • Pharmacy Coordinator

    Highmark Health (Nashville, TN)
    …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
    Highmark Health (10/16/25)
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  • Senior Business Systems Consultant

    Blue Cross and Blue Shield of Minnesota (Eagan, MN)
    …PBM environments; additionally, you will have a strong understanding of PBM claims processing and related technologies. Your Responsibilities * Primary ... to driving successful IT development initiatives within the Pharmacy Benefits Manager (PBM) claims space. As a Senior Consultant, you will serve as a critical… more
    Blue Cross and Blue Shield of Minnesota (10/16/25)
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  • CDU Patient Account Representative

    Guidehouse (Birmingham, AL)
    …denials from payers by timely submitting all information needed to complete claims processing . The Central Denials Account Representative conducts thorough ... Supervisor/Manager areas of concern or areas of improvement. + Resubmit Corrected Claims and supporting documentation as need for the patient experience. +… more
    Guidehouse (10/16/25)
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  • Director, Payer Relations - Shockwave

    J&J Family of Companies (Santa Clara, CA)
    …policy, utilization review, health outcomes, risk management, provider contracting, and claims processing . + Develop relationships with Advisory Committee ... track review periods, and analyze data on medical review, prior authorization, and claims payment trends to inform payer strategy, tactics, and team priorities. +… more
    J&J Family of Companies (10/15/25)
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  • Insurance Collector - Full Time

    Moore County Hospital District (Dumas, TX)
    …payment transfers to ensure deadlines are met. Contact office manager for assistance in claims processing in a timely manner. Answers phone calls and greets ... from multiple payers, ensure discounts and adjustment are correct. Works denied claims daily gathering requested information for resubmittal of a corrected claim.… more
    Moore County Hospital District (10/15/25)
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  • Supervisor, Patient Support

    PSKW LLC dba ConnectiveRx LLC (Whippany, NJ)
    …copay assistance programs. This includes call center services (inbound and outbound) and claims processing operations. They are part of a highly concierge 'white ... of call center needs with expertise in insurance verification and claims + Ability to effectively evaluate performance, resolve complaints, ensure appropriate… more
    PSKW LLC dba ConnectiveRx LLC (10/15/25)
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  • Configuration Management Analyst - Clinical…

    CareFirst (Baltimore, MD)
    …setup of code sets used for configuration in benefits & pricing for claims processing , claims editing configuration set-up and maintenance. Analyzes ... business requirements and objectives towards determining the optimal configuration of the requirements. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit… more
    CareFirst (10/15/25)
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