- Molina Healthcare (Racine, WI)
- …and work PST hours. **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant… more
- UNC Health Care (Chapel Hill, NC)
- …of reported claims and the monitoring of incidents that develop into claims against healthcare providers and staff of UNC Health Care System insured ... and small claims as needed. **Responsibilities** : 1. Manages and conducts claims investigations, gathering data from healthcare providers and employees in a… more
- CGI Technologies and Solutions, Inc. (Wilmington, DE)
- …data formats (EDI, X12, JSON, XML). Domain Expertise . Deep understanding of healthcare claims processing, eligibility, and enrollment systems. . Experience with ... requirements, analyzing processes, and supporting the design and implementation of healthcare applications that improve patient care, claims processing, and… more
- CVS Health (Franklin, TN)
- …routing and outbound calls. **Required Qualifications** + 1-2 years of experience in claims administration, healthcare operations, or a related field. + Strong ... with heart, each and every day. **Position Summary** The Claims Administrator is responsible for routing claims ...The Claims Administrator is responsible for routing claims to the appropriate team functions based on complexity… more
- Guidehouse (Chicago, IL)
- …Databricks, Power BI, Tableau, TIBCO Spotfire or others + Strong understanding of healthcare claims (facility or payer) data and/or HIT applications including ... **:** Engagement Support + Support delivery of project-based analytics for Healthcare consulting engagements across multiple clients and teams concurrently +… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- …and corresponds with insurance companies in an effort to obtain accurate reimbursement for healthcare claims . . Duties include but are not limited to: + Utilize ... companies and healthcare professionals to resolve issues resulting from denied claims + Adhere to coding policies and procedures consistent with the industry… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- …research, and correspond with insurance companies to obtain accurate reimbursement for healthcare claims . This person will also be responsible for analyzing, ... and healthcare professionals to resolve issues resulting from denied claims + Adhere to coding policies and procedures consistent with the industry-standard… more
- CVS Health (Columbus, OH)
- …Experience in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data ... skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste,...investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate… more
- Molina Healthcare (Miami, FL)
- …health, more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver ... through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality… more
- Molina Healthcare (Scottsdale, AZ)
- …health, more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver ... through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality… more