Healthcare Claim Analyst Jobs

Job Information Humana Medicaid Associate Director, Compliance Nursing in Portsmouth New Hampshire 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 of Trend Analytics in Portsmouth New Hampshire 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 - S. Florida in Portsmouth New Hampshire 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 Portsmouth New Hampshire 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 Portsmouth New Hampshire ... 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 Portsmouth New Hampshire Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing ..

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

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

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 - Florida Medicaid in Portsmouth New Hampshire Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..

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

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

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 Senior Care Manager, Behavioral Health (BCBA) in Portsmouth New Hampshire Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of the ..

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

... 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 Medical Director - Texas in Portsmouth New Hampshire 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..

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 ..

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