- CareFirst (Baltimore, MD)
- …and reporting tools technology. **ESSENTIAL FUNCTIONS:** + Fulfill complex regulatory reporting requirements by understanding the external request and working ... priorities. + Able to effectively provide direction to and lead technical teams. + Must be able to meet...+ Understanding of federal, state, and local legislative and regulatory processes, public policy analysis and reporting requirements. +… more
- Prime Therapeutics (Topeka, KS)
- …career? Come build the future of pharmacy with us. **Job Posting Title** Regulatory Analyst Sr - Remote **Job Description** The Senior Regulatory ... Analyst is responsible for leading portions of departmental regulatory review and analysis, external audits and accreditation processes, and participates in… more
- AON (IL)
- Reinsurance Business Analyst Aon are looking to recruit an experienced Reinsurance Business Analyst to join our team in the US. This is a Hybrid position and can ... experience will not be considered for this position. The DXC SICS Application Analyst is responsible for maintaining and enhancing the DXC SICS (Swiss Insurance … more
- Molina Healthcare (OH)
- …identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements and various claims related resources + Strong ... Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data… more
- Elevance Health (Cerritos, CA)
- …non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring ... and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize...regulatory standards and requirements. + As such, the analyst will strictly follow department guidelines and tools to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical ... Essential Accountabilities: Level I . Analyzes and audits acute inpatient claims . Integrates medical chart coding principles, clinical guidelines, and objectivity in… more
- CVS Health (Salt Lake City, UT)
- …skills, with experience in healthcare fraud detection. + Proficiency in interpreting claims data, medical coding, and regulatory frameworks. + Excellent ... it all with heart, each and every day. **Position Summary** The Senior Analyst , Investigations at Aetna International plays a pivotal role in safeguarding the… more
- AIG (Jersey City, NJ)
- Claims Complex Director - Healthcare Professional Liability (HPL) Join us as a Claims Complex Director to take on key responsibilities within a world-class ... claims function. Make your mark in Claims ...determinations, investigations, and trial and resolution strategies. + The analyst will investigate losses, orchestrate defense strategies for healthcare… more
- University of Miami (Miami, FL)
- …of Miami Health System IT Department has an opportunity for a full-time Epic Analyst 2. The Epic Analyst 2 assists Associate Epic Analysts on the ... to optimize the application's configuration, function, and access. The Epic Analyst 2 facilitates day-to-day application support and resolving application issues and… more
- Prime Therapeutics (Springfield, IL)
- …interpreted, and presented by various levels within the organization + Serves as the lead analyst in producing reports, scorecards, or other data using Pharmacy ... build the future of pharmacy with us. **Job Posting Title** Clinical Research Analyst , Senior - Remote **Job Description** The Senior Clinical Research Analyst … more