Healthcare Claim Analyst Jobs

Job Information Humana Medicaid Associate Director, Compliance Nursing in Las Vegas Nevada 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 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 Medical Director - Florida Medicaid in Las Vegas Nevada Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..

Job Information Humana Care Management Support Assistant 3 in Las Vegas Nevada Description Responsibilities The Care Management Support Assistant 3 assists in ensuring TRICARE beneficiaries receive the highest quality health care ..

Job Information Humana Senior Stars Improvement, Clinical Professional - Prime West - Nevada in Las Vegas Nevada Description The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and management ..

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

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

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

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

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

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 ..

... 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 Manages a team of coding educators and reports to Risk Adjustment Director. Responsible for implementing operational and clinical best practices in the risk adjustment methodology, understanding clinical suspects and appropriate ..

Job Description Position Summary EMPLOYER-PAID PENSION PLAN OF 29.75% OF YOUR ANNUAL SALARY! GENEROUS BENEFITS PACKAGE! Position Summary: Performs specialized professional level administrative, organizational, systems, budgetary and related analysis for Hospital ..

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

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

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

... 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..

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

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

Job Description Position Summary EMPLOYER PAID PENSION PLAN OF 29.25% OF YOUR ANNUAL SALARY! GENEROUS BENEFITS PACKAGE! **OPEN TO CURRENT UMC EMPLOYEES ONLY** Responsible for making decisions and completing the application ..

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 ..