Healthcare Claim Analyst Jobs

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

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 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 ..

... 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 RN, Senior Stars Improvement, Clinical Professional in Dover Delaware Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be responsible ..

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

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

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

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

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

Job Information Humana Market Development Advisor - Medicaid Provider Service Operations in Dover Delaware Description The Market Development Advisor - Medicaid Provider Service Operations provides support to assigned health plan and/or ..

... 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..

... 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 Associate Director, Clinical Pharmacy monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, ..

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

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

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

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

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

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 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 ..

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

Job Information Humana Network Operations Lead - Behavioral Health/Medicaid in Dover Delaware Description The Network Operations Lead maintains provider relations to support customer service activities through data integrity management and gathering ..