- Healthfirst (FL)
- …York, NY.** **Duties & Responsibilities** : + Conducts independent assessments of current claims edits to ensure comprehensive and defensible claims editing is ... opportunity with respect to new edits, modifications to existing edits, and recommended claims policy changes. + Leads implementation efforts with respect to new or… more
- DXC Technology (Nashville, TN)
- … claims services and adjudication of health and disability insurance claims , ensuring accuracy, compliance, and high- quality service delivery. **Essential Job ... Functions:** + Execute health and disability claims adjudication and processing, learning from experienced team members while maintaining focus on accuracy. +… more
- Highmark Health (Harrisburg, PA)
- …is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various ... including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims , and Medical Policy. The person in this position must fully… more
- Geisinger (Danville, PA)
- …high dollar claims following internal guidelines. Assists in reviews of quality concerns. + Validates claim payments based on Plan contracts, often working with ... coding, appropriate billing, and reimbursement. + Completes clinical reviews related to Claims , Claim Edits, Appeals and the Grievance process, assisting in analysis… more
- UPMC (Pittsburgh, PA)
- UPMC is hiring Systems Analyst - Associate to join their team. This opportunity offers work life balance, growth, and investment in certification. If you have Revenue ... Maintain confidentiality of sensitive information at all times. + Data Quality : Maintain data quality at all times. + Vendor Relationships: Interact with vendors… more
- Donegal Insurance Group (Marietta, PA)
- …Insurance Group has an opening for a Business Analyst / Quality Assurance Analyst . As a member of our Claims team, this position collaborates with business ... in Computer Science, Business Systems or equivalent experience + 3 years of Business Analyst and/or Quality Assurance Analyst experience with a working… more
- NJM Insurance (Trenton, NJ)
- …(WC) Training and Quality Assurance Management Supervisor, the WC Quality Assurance/Compliance Analyst is responsible for ensuring adherence to state ... Trenton . Essential Duties and Responsibilities: + Assist with coordinating quality and compliance audits/reviews including pre-work such as audit program… more
- Integra Partners (Troy, MI)
- The Quality Assurance Analyst is responsible for... will fairly and consistently review the calls, emails, claims , etc. of our team for accuracy and provide ... quality in support of the departmental goals and initiatives. The Quality Assurance Analyst evaluates both verbal and written customer contact. The Analyst… more
- MetLife (Aurora, IL)
- …Help Us Build a Confident Future (Key Responsibilities): The PFML Senior Operations Quality Analyst is responsible for: * Evaluating and improving business and ... core business challenges within MetLife. This role will conduct quality reviews of disability claims , collecting and...role will conduct quality reviews of disability claims , collecting and analyzing quality opportunities, and… more
- Highmark Health (Harrisburg, PA)
- **Company :** Highmark Inc. **Job Description :** GENERAL OVERVIEW: The Quality analyst is responsible for compiling and analyzing data relevant to the handling ... in claims and/or inquiry processing or equivalent experience in quality + Experience with Microsoft Office Products Preferred + Bachelor's Degree Knowledge,… more