• 100% Remote Senior Medicare Coverage…

    Actalent (Boston, MA)
    Senior Medicare Coverage Analyst As a Senior Medicare Coverage Analyst , you will mentor and train junior staff, ensuring their work aligns with the ... accuracy required in Medicare coverage analysis. You will serve as the expert...coverage analysis. You will serve as the expert on Medicare policies, specifically NCD/LCD, and create detailed coverage analyses… more
    Actalent (08/02/25)
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  • Senior Medicare Coverage Analyst

    Dana-Farber Cancer Institute (Brookline, MA)
    …is fully remote with the ocassional time onsite as needed.** The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, ... and which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies are a Qualifying Clinical… more
    Dana-Farber Cancer Institute (05/18/25)
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  • Medicare Coverage Analyst

    SUNY Upstate Medical University (Syracuse, NY)
    Job Summary: The Medicare Coverage Analyst functions as a key contact person between UMU clinical research departments and sites/hospitals finance for clinical ... trials coverage analyses (CTCA) issues to ensure billing compliance and mitigate risk; reviews budgets on a per-trial basis to ensure accuracy; develop CTCAs timely; documents and disseminates CCA determinations. ensures that final contract terms are… more
    SUNY Upstate Medical University (07/03/25)
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  • Medicare Technical Business Analyst

    Insight Global (Woonsocket, RI)
    …Bach degree or equivalent 2-4 years or more years of Technical Business Analyst experience Medicare or Health Insurance experience: claims, member benefits, ... Job Description Insight Global is seeking a Technical Business Analyst to support a large health insurance client of ours. Work with business partners and technical… more
    Insight Global (07/22/25)
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  • Medicare Risk Adjustment Advanced Analytics…

    Elevance Health (Woodbridge, NJ)
    ** Medicare Risk Adjustment Advanced Analytics Analyst ** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per week,** ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics Analyst ** is...law._ The ** Medicare Risk Adjustment Advanced Analytics Analyst ** is responsible for employing advanced analytics to gain… more
    Elevance Health (07/29/25)
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  • Senior Fraud Investigations Analyst

    BlueCross BlueShield of North Carolina (NC)
    …of degree, 7+ years of experience in related field **Bonus Points** + Deep Medicare and/or Medicare Advantage regulatory experience + Extensive Medicare / ... Medicare Advantage investigative experience **What You'll Get​** + The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community + Work-life balance, flexibility, and the autonomy to do great work +… more
    BlueCross BlueShield of North Carolina (07/25/25)
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  • Regulatory Analyst , Medicare

    Healthfirst (NY)
    …of material reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal stakeholders on developing ... deliverables as needed. + Assists in the preparation of Medicare Part C and D reporting via HPMS, including...knowledge of Microsoft Office Suite applications. + Knowledge of Medicare and CMS guidelines as it relates to member… more
    Healthfirst (06/27/25)
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  • Operational Regulatory Oversight Analyst

    Molina Healthcare (Boise, ID)
    …to the Health Care environment. **Knowledge/Skills/Abilities** The Operational/Regulatory Oversight Analyst works with health plans and operations departments to ... to and compliance with State and Federal regulatory guidelines. The Analyst develops and performs audits and oversight functions involving business-critical… more
    Molina Healthcare (07/19/25)
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  • Senior Business Analyst ( Medicare

    Molina Healthcare (Sterling Heights, MI)
    …business analysis, task and workflow analysis. + Subject matter expert of Medicare and Healthcare enrollment 834 files. + Interpret customer business needs and ... translate them into application and operational requirements + Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as… more
    Molina Healthcare (07/27/25)
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  • Senior Actuarial Analyst ( Medicare

    Molina Healthcare (Des Moines, IA)
    **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... Extracts, analyzes, and synthesizes data from various sources to identify risks. Maintain/update SQL model(s), estimate risk scores, and analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment… more
    Molina Healthcare (07/25/25)
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