Healthcare Claim Analyst Jobs

Job Information Humana Medicaid Associate Director, Compliance Nursing in Jersey City New Jersey Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, ..

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 The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..

Job Information Humana Medical Director - Texas in Jersey City New Jersey Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..

Job Information Humana Medical Director of Trend Analytics in Jersey City New Jersey Description Humana's ECM organization is seeking a Medical Director of Trend Analytics. As a clinical trend leader you ..

Job Information Humana Market Development Advisor - Medicaid Provider Service Operations in Jersey City New Jersey Description The Market Development Advisor - Medicaid Provider Service Operations provides support to assigned health ..

Job Information Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at Home in Jersey City New Jersey Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of ..

Job Information Humana Medical Director - Florida Medicaid in Jersey City New Jersey Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve ..

Job Information Humana Manager, Pharmacy and Medical Trend in Jersey City New Jersey Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy ..

... looking for an experienced Senior Healthcare Investigator to join its industry ... Qualifications Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 3 years of..

Job Information Humana VBP Data & Reporting Lead in Jersey City New Jersey Description The Data and Reporting Lead generates ad hoc reports and regular datasets or report information for end-users ..

Job Information Humana RN, Senior Stars Improvement, Clinical Professional in Jersey City New Jersey Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will ..

Job Information Humana Associate Director, Health Information Management in Jersey City New Jersey Description The Associate Director, Health Information Management ensures data integrity and quality for our encounter submissions systems. The ..

... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..

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 ..

Job Information Humana Network Operations Lead - Behavioral Health/Medicaid in Jersey City New Jersey Description The Network Operations Lead maintains provider relations to support customer service activities through data integrity management ..

Job Information Humana Senior Care Manager, Behavioral Health (BCBA) in Jersey City New Jersey Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of ..

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 ..

Job Information Humana UM Medical Director - Conviva in Jersey City New Jersey Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve ..

... Qualifications Bachelor's degree in a healthcare field or equivalent experience. 5 ... years of experience in managed healthcare analysis, preferably as a Business ... analysis, preferably as a Business..

Description The Health Information Management Professional ensures data integrity for claims errors. The Health Information Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate ..

... Humana Lead Product Manager - Healthcare API in Jersey City New ... The Lead Product Manager - Healthcare API (SME) as part of ... Individual will be leveraging previous..

Job Information Humana Medical Director - S. Florida in Jersey City New Jersey Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve ..