- The Cigna Group (Bloomfield, CT)
- … systems configuration within the claims adjudication engine. The Claims Systems Configuration Associate will ensure data integrity, data ... a division of The Cigna Group is hiring a** ** Claims System Configuration Associate ** **....data experience, required** **1+ years of experience in medical claims systems configuration , preferred** **Experience… more
- Molina Healthcare (Dallas, TX)
- …of critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each ... **KNOWLEDGE/SKILLS/ABILITIES** + Analyze and interpret data to determine appropriate configuration changes. + Accurately interprets specific state and/or federal… more
- Huron Consulting Group (Chicago, IL)
- …Evidence of Coverage (EOC), and Summary of Benefits into accurate, system-ready configuration specifications. + Partner with Product, Claims , Enrollment, and IT ... growth, optimize internal processes and deliver better consumer outcomes. Health systems , hospitals and medical clinics are under immense pressure to improve… more
- CareFirst (Baltimore, MD)
- …membership configuration set-up and maintenance, setup of code sets used for configuration in benefits & pricing for claims processing, claims editing ... core care management and clinical appeals workflows. + Assesses how proposed configuration management changes may impact systems sustainment and supportability… more
- Huron Consulting Group (Chicago, IL)
- …growth, optimize internal processes and deliver better consumer outcomes. Health systems , hospitals and medical clinics are under immense pressure to improve ... and create your future. Huron is looking for a highly skilled NetworX Configuration SME to oversee the configuration , maintenance, and optimization of provider… more
- Commonwealth Care Alliance (Boston, MA)
- …or configuration updates. + Document all research, findings, and outcomes in claims systems (eg, Salesforce, Facets) in compliance with audit standards and ... 011250 CCA- Claims **_This position is available to remote employees...Provider Relations, Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams to validate and resolve reimbursement concerns. +… more
- Molina Healthcare (Meridian, ID)
- …issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems . ... + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from… more
- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- **Job Summary** The Associate Director, Communications Engineer designs, implements, manages, and maintains network communications systems and supporting ... platforms and networking environments. + Designs and implements network communications systems such as Blackberry, and client remote access systems .… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan has an exciting opportunity for a QA Anlyst, Associate in the Operatonal Risk Integrity department. This is a full time position working Monday ... working from home and in the office two days per week. The Insurance Auditor Associate is primarily responsible for the review of high dollar claims and… more
- Molina Healthcare (Orem, UT)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as ... demographic information and coordinates communication of such information to Provider Configuration team. * Sends out new provider welcome packets to providers… more