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 ..

Description The Senior Claims Research & Resolution Professional works with operational teams, vendors, providers, and members in the processing of claims. Strong analytical skills focusing on accuracy and attention to detail. ..

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 Market Network Operations Lead (Behavioral Health) - KY Medicaid in Cincinnati Ohio Description The Behavioral Health Network Operations Lead will be our Subject Matter Expert on Kentucky Medicaid ..

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

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

Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments ..

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

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

Job Information Humana Medical Director - Florida Medicaid in Cincinnati Ohio 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 Cincinnati Ohio Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative ..

... 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 UM Medical Director - Conviva in Cincinnati Ohio Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..

Description The Mail Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. Responsibilities The Mail Operations Pharmacy Technician 2 ensures ..

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

Job Information Humana Medical Director - S. Florida in Cincinnati Ohio 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..

... 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 Cincinnati Ohio Description ... The Lead Product Manager - Healthcare API (SME) as part of ... Individual will be leveraging previous..

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 Cincinnati Ohio Description The Network Operations Lead maintains provider relations to support customer service activities through data integrity management and gathering ..

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 Senior Care Manager, Behavioral Health (BCBA) in Cincinnati Ohio Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of the Autism ..