Healthcare Claim Analyst Jobs

The healthcare consultant will perform the following responsibilities: Conduct analysis of health plan and provider functional areas to identify impacts, opportunities and risks related to the implementation of ICD-10, create high ..

Job Information Humana Medicaid Associate Director, Compliance Nursing in Washington District Of Columbia 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 ..

Job Information Humana Senior Care Manager, Behavioral Health (BCBA) in Washington District Of Columbia Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring 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 Associate Director, Health Information Management in Washington District Of Columbia Description The Associate Director, Health Information Management ensures data integrity and quality for our encounter submissions systems. The ..

Job Information Humana Medical Director - Texas in Washington District Of Columbia 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 Washington District Of Columbia Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy ..

Job Information Humana Medical Director of Trend Analytics in Washington District Of Columbia Description Humana's ECM organization is seeking a Medical Director of Trend Analytics. As a clinical trend leader you ..

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 Washington District Of Columbia Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve ..

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 Washington District Of ... The Lead Product Manager - Healthcare API (SME) as part of ... Individual will be leveraging previous..

Job Information Humana Medical Director - S. Florida in Washington District Of Columbia Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve ..

Job Information Humana Care Management Support Assistant 3 in Washington District Of Columbia Description Responsibilities The Care Management Support Assistant 3 assists in ensuring TRICARE beneficiaries receive the highest quality health ..

... 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 Network Operations Lead - Behavioral Health/Medicaid in Washington District Of Columbia Description The Network Operations Lead maintains provider relations to support customer service activities through data integrity management ..

Job Information Humana Medical Director - Florida Medicaid in Washington District Of Columbia Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve ..

... 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 Market Development Advisor - Medicaid Provider Service Operations in Washington District Of Columbia Description The Market Development Advisor - Medicaid Provider Service Operations provides support to assigned health ..

Job Information Humana VBP Data & Reporting Lead in Washington District Of Columbia Description The Data and Reporting Lead generates ad hoc reports and regular datasets or report information for end-users ..

Mercy Clinic is seeking a Nurse Practitioner to join a premiere medical group practice in Washington, Missouri. Mercy McAuley Clinic serves uninsured and underinsured patients in the community.   This Position Offers:Part-time ..

Job Information Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at Home in Washington District Of Columbia Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of ..