- Molina Healthcare (Buffalo, NY)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting,… more
- Molina Healthcare (Syracuse, NY)
- **Job Description** **Job Summary** We are seeking a highly experienced Lead Analyst , Configuration Oversight to support our Payment Integrity and Claims ... identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements and various claims related resources + Strong… more
- Molina Healthcare (Yonkers, NY)
- …**Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan financial ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- Highmark Health (Albany, NY)
- …MUST BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, ... proactively identifying, assessing, and mitigating compliance risks. The Analyst will monitor regulatory changes, interpret their impact on operational… more
- City of New York (New York, NY)
- …Transactions Monitoring Unit (TMU) in the Compliance Department, the Senior Compliance Analyst will develop a program to monitor procurement of capital projects ... regulations as well as agency procedures. In addition, the Senior Compliance Analyst may be assigned to specialized compliance-related projects stemming from new… more
- Independent Health (Buffalo, NY)
- …innovation and collaboration. **Overview** The Provider Contracting & Reimbursement Analyst -Intermediate will analyze utilization, claims , membership, and cost ... drawing statistically sound conclusions, and presenting results to management. The Analyst will interpret, analyze, and recommend courses of action to management… more
- MVP Health Care (Schenectady, NY)
- …and continuous improvement. To achieve this, we're looking for a **Professional, Quality Analyst ** to join #TeamMVP. This is the opportunity for you if you have ... quality data highly preferred + Subject matter expertise in healthcare data- claims , coding, HIE's etc. Experience with quality metrics, (NCQA HEDIS and NYS… more
- WTW (New York, NY)
- …of contact for your clients in all aspects of their insurance program, any claims , wording, coverage or industry news related queries are directed to you, so these ... Submission' document, containing in-depth information about a client's business including claims information, the classes of business needing renewal and any other… more
- AIG (New York, NY)
- …data driven insights that will support Underwriting and Portfolio Management. + Lead the quarterly portfolio roll-up and reporting operations for select North ... American Commercial, and Specialty portfolios. + Work closely with actuarial, claims , and other functions, integrating catastrophe modelling insights into day-to-day… more
- Highmark Health (Albany, NY)
- …5 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 3 years of project leadership ... and non-technical, and internal and external audiences, and the ability to lead through influence + Healthcare industry expertise and experience, knowledge about the… more
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