- Insight Global (Alpharetta, GA)
- …vector databases and building efficient data pipelines for RAG. Experience within the healthcare industry Experience working with claims and healthcare ... This role is responsible for the full lifecycle of AI feature delivery-from crafting best-in-class prompts and designing autonomous agents to ensuring secure, performant, and reliable deployment within mission-critical enterprise systems. The ideal candidate… more
- Delta Dental of Iowa (Johnston, IA)
- …technologies (eg, Docker, Kubernetes), and CI/CD pipelines. + Familiarity with healthcare or insurance systems, including claims processing, enrollment, or ... build and maintain innovative, secure, and scalable applications that support our healthcare insurance operations. This is an opportunity to use your technical… more
- PruittHealth (Norcross, GA)
- …* Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections * Familiarity with Insurance Claims management functions ... all Insurance billing services by final/higher level auditing, correcting, and submitting claims . Ensures that billing services are timely, accurate, and allow for… more
- BrightSpring Health Services (Nashville, TN)
- …managing Professional Billing / Revenue Cycle Management and/or Collections in a large healthcare provider setting or a Medical Claims Processing organization. + ... Sr Director's responsibilities include identifying reimbursement issues, ensuring that claims , denials, and appeals are efficiently processed, and resolving… more
- Prime Therapeutics (Baton Rouge, LA)
- …analysis to include 5 years of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare , and/or related field** **3 years of experience ... using Tableau, SQL, SAS, Alteryx, Teradata, R, or Python technologies** **Must be eligible to work in the United States without the need for work visa or residency sponsorship** **Additional Qualifications** **Extensive PBM industry knowledge and deep… more
- CVS Health (Hartford, CT)
- …integration services, API platforms, and microservices architecture principles + Experience in healthcare domains such as claims , providers, and eligibility + ... Familiarity with cloud networking and firewall implementation for new platforms + Exceptional teamwork and collaboration skills, with a growth mindset focused on agility and continuous improvement + Solid understanding of core programming and computer science… more
- Catholic Health Initiatives (Bryan, TX)
- …and objectives. Responsible for assisting patients with questions on insurance claims , home healthcare , and medical equipment. Responsible for administering, ... directing, planning, and coordinating all office activities. Provides information to patients so they may fully use and benefit from clinic/office services. **Job Requirements** **_Education_** Required: High school graduate **_Experience_** Minimum 1 year… more
- LA Care Health Plan (Los Angeles, CA)
- …navigate multiple programs/databases while assisting each caller. Proficient knowledge in healthcare product lines, medical terminology and claims processes. ... One (1) inquiries, this includes but not limited to, general inquiries on claims processing and status and eligibility verification. In addition, this position will… more
- Molina Healthcare (NM)
- JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Molina Healthcare (NE)
- …Duties** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, ... likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by… more