Analyst, Claims and Configuration

Job DescriptionJob Description The focus of this position will be research and root cause analysis of claims / config issues with direct provider interaction and collaboration with our provider relations team. Additionally, the role will help with overpayment recovery, claims payment and adjustment projects, and reviewing proposed SAI concepts from PI and...

Job description Our company is seeking an experienced QNXT Configuration Analyst to join our Health Claims Team. As a Configuration Analyst, These positions will be responsible for the implementation and support of quality initiatives within assigned areas, specifically to support the implementation of Commercial LOBs into QNXT. These Business Analysts will...

Job description Our company is seeking an experienced QNXT Configuration Analyst to join our Health Claims Team. As a Configuration Analyst, These positions will be responsible for the implementation and support of quality initiatives within assigned areas, specifically to support the implementation of Commercial LOBs into QNXT. These Business Analysts will...

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for 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...

The purpose of the Sr. Provider Data Analyst is to analyze complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and...

**Remote and must live in the United States preferably in the Mountain time zone** Job Summary KNOWLEDGE/SKILLS/ABILITIES Establish and maintain internal standard operating procedures, and enterprise-wide policies and procedures pertaining to Provider functions ensuring alignment with business objectives. Collaborate with departments on issues related to...

Job Description Job Summary Job Duties Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects Assists with reducing re-work by identifying and remediating claims processing issues Locate and interpret regulatory and contractual requirements Tailors existing reports or available data...

Job Summary KNOWLEDGE/SKILLS/ABILITIES Trains staff on configuration functionality, enhancements, and updates. Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise. Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been...

**Requisition ID**:R10155976**: - ** Category**: Technical Support - ** Location**: Redondo Beach, California, United States of America - ** Citizenship required**: United States Citizenship - ** Clearance Type**: Secret - ** Telecommute**: No - Teleworking not available for this position - ** Shift**: 1st Shift (United States of America) - ** Travel...

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for 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...

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for 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...

**_Appeals & Grievances Health Claims Processing Specialist (REMOTE)_**Position Summary**: Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and providers (or authorized representatives) following the standards and requirements established by the Centers for Medicare and Medicaid. **Position...

Job Summary KNOWLEDGE/SKILLS/ABILITIES Maintains department standard for loading of provider demographic data with affiliation and contract assignment. Load and maintain provider information into computer system(s) with attention to detail and accuracy in a timely manner to meet department standards of turnaround time and quality. Audit loaded provider...

Job Summary KNOWLEDGE/SKILLS/ABILITIES Analyze and interpret data to determine appropriate configuration changes. Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters. Handles coding, updating and maintaining benefit plans, provider...

Your Role The Claims Shared Support Services team actively engages in providing and eliciting business requirements for system enhancements, by identifying a desired future state that addresses a business problem utilizing multiple analytic methods interviewing, brainstorming, chair-siding/observation, problem identification, and gap analysis. The...

Job DescriptionJob DescriptionPosition: Business Analyst with EZ-CAP ExperienceWork Mode: RemoteResponsibilities and Requirements: Business Analysts (BAs) that know EZ-CAP. Have expertise to assist with configuration activities like contracts, benefits, fee schedules etc. Claims adjudication and troubleshooting. Knowledge of EZ-CAP backend data model, SQL...

Job DescriptionJob DescriptionPosition: Business Analyst with EZ-CAP ExperienceWork Mode: RemoteResponsibilities and Requirements: Business Analysts (BAs) that know EZ-CAP. Have expertise to assist with configuration activities like contracts, benefits, fee schedules etc. Claims adjudication and troubleshooting. Knowledge of EZ-CAP backend data model, SQL...

Job Description Job Summary The Analyst, Encounters is responsible for monitoring inbound and outbound encounters processes and ensuring timely, accurate, and complete encounter submissions for low - to moderate-complexity markets or states. Performs data analysis using internal and external sources, analyzes processes and provides recommendations for...

We are seeking a detail-oriented and motivated individual to join our team as an Epic PB Analyst. In this role, you will be responsible for supporting the configuration, testing, and optimization of the Epic PB (Professional Billing) module, ensuring accurate and timely processing of professional billing claims. The ideal candidate will have a strong...

Job Description **This remote position will have standard PST business hours** Job Summary The Analyst, Encounters is responsible for monitoring inbound and outbound encounters processes and ensuring timely, accurate, and complete encounter submissions for low - to moderate-complexity markets or states. Performs data analysis using internal and external...