Claims Research Analyst

Job 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 provide guidance...

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 Summary Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Interacts with health plans and vendors regarding recovery outstanding overpayments. Job...

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...

**_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 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...

Job DescriptionJOB DESCRIPTIONJob SummaryAnalyzes data for cost savings opportunities and performance improvement initiatives. Researches healthcare utilization and claims experience to identify areas of growth. Collaborates with Finance and corporate actuarial teams on IBNR calculations, capitation rate review, rate advocacy, and forecasting....

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 SummaryAnalyzes data for cost savings opportunities and performance improvement initiatives. Researches healthcare utilization and claims experience to identify areas of growth. Collaborates with the KY Finance and corporate actuarial teams on IBNR calculations, capitation rate review, rate advocacy, and forecasting. This is...

Job DescriptionJob DescriptionDescription:Responsible for receiving and processing all lawsuits for active/effective VLP members and the creation of new profiles for prospects with pre-existing lawsuits. The Claims Agent is responsible for ensuring we have all legal documents needed to set up a claim, creating claims, assigning attorneys, ensuring pleadings...

Job DescriptionJOB DESCRIPTIONJob SummaryAnalyzes data for cost savings opportunities and performance improvement initiatives. Researches healthcare utilization and claims experience to identify areas of growth. Collaborates with Finance and corporate actuarial teams on IBNR calculations, capitation rate review, rate advocacy, and forecasting....

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**Company Overview**: Voyager Global Mobility and its subsidiaries play a central role in urban transportation in some of the most dynamic cities throughout the Americas. We power more than 10,000 drivers with professionally managed vehicles and resources so they can succeed as entrepreneurs in the ride-sharing economy. Our fleet-as-a-service model—a...

Job Description **Job Description**: **This job position will work EST 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...

Job DescriptionJOB DESCRIPTIONJob SummaryAnalyst, Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality care with improved outcomes through better coordination and...

Market Research Analyst. Research market conditions and gather information to determine potential sales of services and products. Must have Bachelor’s Degree in Market Research or Business Administration or foreign degree equivalent and two years of experience on the job. Mail resume w/cover letter at Optimar Realty Group LLC., 18246 Collins Ave. Sunny...

Market Research Analyst. Research market conditions and gather information to determine potential sales of services and products. Must have Bachelor’s Degree in Market Research or Business Administration or foreign degree equivalent and two years of experience on the job. Mail resume w/cover letter at Optimar Realty Group LLC., 18246 Collins Ave. Sunny...

Job DescriptionJOB DESCRIPTIONJob SummaryPerforms research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant...

Job DescriptionJob DescriptionJob Summary The Sr Analyst, Risk Adjustment - Predicitve Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs and develops Suspect, Targeting, and Tracking System to suport Molina's Prospective and Retrospective Interventions. Assist with research, development,and completion of special projects....

Job DescriptionJob Description Job SummaryThe Sr Analyst, Risk Adjustment - Predicitve Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs and develops Suspect, Targeting, and Tracking System to suport Molina's Prospective and Retrospective Interventions. Assist with research, development,and completion of special...