Healthcare Claim Analyst Jobs

The healthcare consultant will perform the following responsibilities: Conduct analysis of health plan and provider functional areas to identify impacts, opportunities and risks related to the implementation of ICD-10, create high ..

Actuarial Analyst II,III - Any Anthem Office ... filled as either an Actuarial Analyst II or an Actuarial Analyst III depending on experience and ... at the managers discretion. Actuarial..

Description The Senior Claims Research & Resolution Professional works with operational teams, vendors, providers, and members in the processing of claims. Strong analytical skills focusing on accuracy and attention to detail. ..

... aspects related to reviewing pharmacy claim submissions for accuracy and appropriateness. ... tone and standard for pharmacy claim review. The Pharmacy Claims Professional ... pharmacies, make determination of appropriate..

Description The Claims Review Representative 4 (formerly Team lead), Financial Recovery Overpayment Team makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. ..

Job Information Humana Senior Risk Management Professional - Pharmacy claims in Cincinnati Ohio Description The Senior Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The Senior ..

Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments ..

Job Information Humana Call Center Pharmacy Claims Technician, Remote in Cincinnati Ohio Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative ..

Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..

Description Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing with the sub-contractor to gather and track associated reporting. The Consumer Service Operations Professional 2 evaluates ..

Description The Mail Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. Responsibilities The Mail Operations Pharmacy Technician 2 ensures ..

Job Information Humana Senior Process Improvement Professional/HGB (TRICARE Benefits, Claims processing exp.) Remote Nationwide in Cincinnati Ohio Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business ..

Description The Business Intelligence Lead solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Business Intelligence Lead works on problems of ..

Description The Senior Finance Analyst collects, analyzes and reports on various market data to connect financial outcomes with operational effectiveness. The Senior Finance Analyst work assignments involve moderately complex to complex ..

... Humana Lead Product Manager - Healthcare API in Cincinnati Ohio Description ... The Lead Product Manager - Healthcare API (SME) as part of ... Individual will be leveraging previous..

Job Information Humana Senior Financial Analyst - Remote in Cincinnati Ohio ... vision is to improve member healthcare through innovative analytics and actionable ... is seeking a Senior Financial Analyst..

... this role the Business Intelligence Analyst solves complex business problems and ... to decision-makers. The Business Intelligence Analyst work assignments are varied and ... well-being Responsibilities The Business Intelligence..

Job Information Humana Senior Financial Analyst - Remote Nationwide in Cincinnati ... Ohio Description The Senior Financial Analyst for Humana's Direct Contracting Entity, ... operational effectiveness. The Senior Financial Analyst..

Description The STARS Improvement Analyst develops, implements, and manages oversight ... and initiatives. The STARS Improvement Analyst work assignments are varied and ... well-being Responsibilities The STARS Improvement Analyst develops..

Job Information Humana Pharmacy Claims Specialist, Remote in Cincinnati Ohio Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative 2 performs ..

Description The Senior Business Intelligence Analyst (Claims Strategy) solves complex business ... decision-makers. The Senior Business Intelligence Analyst work assignments involve moderately complex ... In The Senior Business Intelligence Analyst..

Description The Business Intelligence 2 - Provider Intelligence and Claims Analytics (PICA) solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The ..

Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..