Healthcare Claim Analyst Jobs

Job Information Humana Medicaid Associate Director, Compliance Nursing in Springfield Missouri 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 ..

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

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

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

Job Information Humana Medical Director - Florida Medicaid in Springfield Missouri 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 Springfield Missouri Description The Associate Director, Health Information Management ensures data integrity and quality for our encounter submissions systems. The Associate Director, ..

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

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

Job Code 2156966 Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ..

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

... 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 Market Development Advisor - Medicaid Provider Service Operations in Springfield Missouri Description The Market Development Advisor - Medicaid Provider Service Operations provides support to assigned health plan and/or ..

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

Job Information Humana Medical Director of Trend Analytics in Springfield Missouri 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 Springfield Missouri Description The Network Operations Lead maintains provider relations to support customer service activities through data integrity management and gathering ..

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

... 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 Medical Director - Texas in Springfield Missouri Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to ..

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 Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at Home in Springfield Missouri Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business ..