Healthcare Claim Analyst Jobs

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

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 Our search is focused on identifying an individual contributor who will take ownership of Medicare risk adjustment programs that fit best with our providers by implementing operational and clinical best ..

Job Information Humana Medical Director of Trend Analytics in Colorado Springs Colorado Description Humana's ECM organization is seeking a Medical Director of Trend Analytics. As a clinical trend leader you will ..

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

Job Information Humana Medical Director - Texas in Colorado Springs Colorado Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..

... 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..

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

Job Information Humana UM Medical Director - Conviva in Colorado Springs Colorado Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..

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

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

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

Description Our search is focused on identifying an individual contributor who will take ownership of Medicare risk adjustment programs that fit best with our providers by implementing operational and clinical best ..

... 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 Network Operations Lead - Behavioral Health/Medicaid in Colorado Springs Colorado Description The Network Operations Lead maintains provider relations to support customer service activities through data integrity management and ..

Job Information Humana Medical Director - Florida Medicaid in Colorado Springs Colorado Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..

Job Information Humana RN, Senior Stars Improvement, Clinical Professional in Colorado Springs Colorado Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be ..

Job Information Humana Medical Director - S. Florida in Colorado Springs Colorado Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..

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

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

... 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..

Job Information Humana Sr Medicare Risk Adjustment Coding & Documentation Improvement Professional - WAH AZ or CO in Colorado Springs Colorado Description Sr Medicare Risk Adjustment Coding & Documentation Improvement Professional ..