- Elevance Health (Chicago, IL)
- …years at the executive level. + Proven track record of delivering large-scale healthcare technology solutions ( claims systems, care management platforms, or cost ... for building advanced analytics platforms, AI/ML-driven decision support tools, claims optimization systems, and clinical insights platforms that enable Elevance… more
- AssistRx (Orlando, FL)
- …clients or working in a vendor/partner-facing environment. + Background working with healthcare claims , pharmacy data, EMR/EHR datasets, or specialty pharma ... technology and services, partnering with pharmaceutical manufacturers, specialty pharmacies, and healthcare providers to help patients start and stay on therapy… more
- Evolent (Lincoln, NE)
- …seamlessly with diverse teams and stakeholders. + Deep understanding of healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including ... preferred. + 10+ years of analytics & reporting experience in healthcare , including medical economics, cost/utilization analysis, and membership trend reporting. +… more
- TEKsystems (Chicago, IL)
- …applications within the TriZetto Facets platform, a core system used by healthcare payers for claims processing, member management, and provider services. ... + Experience working with TriZetto Facets platform. + Strong knowledge of healthcare payer systems ( claims , enrollment, billing, provider management). +… more
- Molina Healthcare (Meridian, ID)
- **Job Description** **Job Summary** The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims , coordinating, ... investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge… more
- Molina Healthcare (Atlanta, GA)
- JOB DESCRIPTION **Job Summary** Provides support for provider claims adjudication activities including responding to providers to address claim issues, and ... researching, investigating and ensuring appropriate resolution of claims . **Essential Job Duties** * Provides support for resolution of provider claims issues,… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION Job Summary Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, ... overpayments, and claims processing errors. **Essential Job Duties** + Audits the...position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Molina Healthcare (Tacoma, WA)
- JOB DESCRIPTION **Job Summary** Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory ... with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** * Serves as … more
- Molina Healthcare (Kearney, NE)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal ... to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion… more
- Martin's Point Health Care (Portland, ME)
- …years management and/or leadership experience, with a focus on Payment Integrity, claims operations, healthcare auditing, or related roles. + Experience managing ... claim payments. This role focuses on preventing overpayments, identifying incorrect claims , and leading recovery efforts while improving system controls and… more