Appeals Analyst I: Health Insurance Claims & Compliance
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced Analyst to manage end-to-end complaint and appeal cases, conducting investigations and preparing clear determinations for leadership and external regulators. The incumbent collaborates with various internal and external stakeholders to resolve cases in a timely, accurate manner. The role supports Medicaid and Medicare compliance, including awareness of impacts to STARS performance, and prepares comprehensive case files for #J-18808-Ljbffr Horizon Blue Cross Blue Shield of New Jersey
$63k - $84.42k
...end complaint and appeal cases, conducting... ...regulatory and policy compliance, and documenting... ...of Banking and Insurance as needed and supports... ...performance. The Analyst prepares... ...exhibits include claim records, authorizations... ...inquiries. Experience in health insurance, claim...Health InsuranceInsurance claimsContract workLive inWork at officeLocal area- Naukri Mitra is seeking a remote Health Insurance QA Analyst to audit claims, benefits setup, and member eligibility while ensuring compliance with federal and state regulations. The role collaborates with compliance, IT, and claims teams to improve QA standards and drive...Health InsuranceInsurance claimsRemote job
- ...package. The Actuary will evaluate risk for underwriting and claims teams, providing insights to ensure financial stability. You'... ...employees can benefit from a comprehensive package that includes health insurance, retirement plans, and opportunities for professional...Health InsuranceInsurance claimsFull timeWork at office
$68.04k - $118.8k
...payment data. Utilize pre/post claim editing, auditing, and claim... ...recovery and ensure compliance with regulatory and contractual... ...4 - 6+ years’ experience in health care healthcare industry, managed... ...Technical knowledge of health insurance claims/Financial Recovery/Vendor...Health InsuranceInsurance claimsRemote work- ...Practicum experience. The candidate will research and appeal unpaid claims in a timely manner and handle charge entry and insurance posting. Remote onboarding is provided, and... ...offers benefits such as Paid Time Off, 401k, Health Insurance and Paid Holidays. Ideal candidates...Health InsuranceInsurance claimsWork at officeRemote work
$55k - $65k
...resolving complex healthcare insurance claim denials and delays. Our... ...is to empower hospitals and health systems by optimizing their... ...providers in administrative appeals for denied insurance claims.... ...Commitment to upholding HIPAA compliance and company policies. Why Join...Health InsuranceInsurance claimsRemote workFlexible hours- Arkansas Blue Cross and Blue Shield is seeking an Appeals Analyst to review and respond to member, provider... ...accurate documentation, data analysis, and cross-functional collaboration with claims and compliance teams to #J-18808-Ljbffr 01 USAble Mutual Insurance CompanyRemote jobWork from home
$70.5k - $94.4k
...empowers our members to achieve their best health. For over 90 years , we have been New... .... About the Role This entry-level analyst position resides within the Actuarial Department... ...the organization to analyze health insurance claims and patient utilization data to track...Health InsuranceInsurance claimsLive inLocal area- ...Imagine360 is currently seeking a Sales Operations Analyst to join our team! In the role of Sales Operations Analyst, you will be responsible for leveraging prospective client health insurance claim information to conduct analysis to determine how much savings they can...Health InsuranceInsurance claimsRemote work
- Horizon Blue Cross Blue Shield of New Jersey is seeking an GP Appeals Analyst I in Hopewell, NJ. The role focuses on end-to-end complaint... ...regulatory guidelines, with collaboration across Legal, Compliance, and Regulatory Affairs. You will prepare case files for leadership...Remote job
$37.6k - $64.4k
the company is a nonprofit health plan with more than a million members that serves communities... ...and every member feels valued. The Claim Appeals & Correspondence II position is... ...Preferred Qualifications Experience in health insurance, healthcare administration, or claims...Health InsuranceInsurance claimsWork experience placementRemote work- ...: Investigate, evaluate, and resolve insurance/reinsurance claims across multiple lines of business. Engage... ...coverage issues across jurisdictions Compliance with multi-state adjuster licensing... ...for this role is between: Benefits: Health, Dental and Disability Insurance a...Health InsuranceInsurance claims
- Naukri Mitra is seeking a Remote Health Insurance Claims Examiner to evaluate and adjudicate claims with HIPAA compliance, accuracy, and compassion. The role supports members nationwide while working from home. You will review claims using ICD-10, CPT, and HCPCS codes,...Health InsuranceInsurance claimsRemote jobWork from home
- Naukri Mitra is seeking a Remote Health Insurance Claims Processor to review and adjudicate claims from home. You will verify submissions, ensure policy compliance, and resolve discrepancies while maintaining strong provider and patient communication. The role emphasizes...Health InsuranceInsurance claimsRemote job
$65k - $75k
...Working for a leader in the insurance industry means... ...& Casualty Corporate Claims provides shared services... ...The Litigation Services Analyst supports the oversight... ...legal invoices for compliance with company billing guidelines... ...and resolve billing appeals and disputes submitted...Health InsuranceInsurance claimsHourly payFull timePart timeSeasonal workRemote work$35 - $46 per hour
...seeking an experienced Business Analyst to support enhancements and... ...will work closely with the Claims, Development, and QA teams to... ...and driving clarity in complex insurance systems. What You’ll Be... ...internal processes, standards, and compliance needs What We’re Looking For...Insurance claimsContract workRemote work- ...mission-driven mental health practice focused on delivering... ...a detail-oriented RCM Analyst to manage and optimize... ...for ensuring accurate claim submissions, resolving... ..., submit, and track insurance claims via Office Ally... ...and coding compliance. Identify and recommend...Insurance claimsWork at officeRemote work
- Naukri Mitra in the United States is seeking a Remote Health Insurance Compliance Analyst to uphold ethical healthcare practices while working from... ...compliance standards across digital insurance workflows, claims analysis, and regulatory documentation. You'll translate...Health InsuranceInsurance claimsRemote jobWork from home
- ...SpecialistRisk Adjustment is a growing and critical field within Health Insurance Finance. This is your opportunity to support this function at... ...the enterprise data warehouse to evaluate member, provider, claims, and enrollment data in support of Risk Adjustment and...Health Insurance
- Caron Treatment Centers is seeking a Risk Analyst to support Emergency Preparedness, Safety, and Insurance/Claims Management across locations. You will coordinate drills... ...days, and a commitment to healthcare quality and compliance are essential. #J-18808-Ljbffr CaronInsurance claimsWork at office
$41.1k - $53.4k
Job Summary: The Appeals Analyst reviews and responds to appeals... ...representatives, insurance departments, and/or... ...grievances, appeals, claims processing, claims research... ...Solving Business Compliance Claims Management... ...Cross, we care about the health, wellness, and...Health InsuranceContract workWork at officeRemote workWork from home- ...at our Wernersville, PA campus. Risk Analyst Main Duties and Responsibilities: Conduct... ...emergency drill reports to ensure compliance with Caron’s emergency procedures and... ...agencies as requested by the Supervisor. Insurance and Claims Management Assist with reviewing insurance...Insurance claimsFull timeWork at officeRemote workHome officeMonday to Friday
$75k - $95k
...maintenance, staffing, financial health, accessibility, and program compliance. Additionally, the... ...include: Health insurance - two plan options, employee... ...respond to tenant issues and appeals in a timely fashion. 8.... ...for all insurance claims. Work with the corporate...Health InsuranceInsurance claimsFull timeContract workTemporary workWork at officeLocal areaRemote workMonday to Friday- ...401K with match, company-paid life insurance and disability coverage. Cell phone... ...always govern. Job Summary The Risk Analyst is a support position within the... ...administration of risk management, insurance, claims management and safety compliance initiatives. The above will be...Insurance claimsHourly payCasual workWork at officeRemote workWork from home
$80k - $100k
...administration of Tishman Speyer's global insurance and risk management programs. The role... ...and administer insurance programs, manage claims, review contractual insurance... ...endorsements. Coordinate lender insurance compliance. Manage claims with brokers, carriers...Insurance claimsWork at officeLocal areaFlexible hours- ...Property & Casualty (P&C) Business Analyst with strong data analysis... ...deep knowledge of P&C insurance processes, data-driven decision... ...stakeholders, underwriting, claims, actuarial, and operations teams... ...defect resolution. Ensure compliance with insurance regulations...Health InsuranceInsurance claimsPermanent employmentFull timeLocal area3 days per week
- Put your Insurance Experience to work - FROM HOME! At WAHVE, we value... ...in Operations Business Analyst positions. Responsibilities may... ...as underwriting, accounting, compliance, audit, information technology... ...BECOMING A WAHVE VINTAGE EXPERT Health insurance based on...Health InsuranceRemote jobFull timePart timeWork experience placementWork at officeWork from home
$45k - $65k
...Title : Enterprise Risk Analyst, CorpInsurance & Worker's Comp Claims Location : Remote, USA... ...your career in corporate insurance risk and workers’ compensation... ..., claims activity, and compliance requirements. You will... ...well as our individual health and well‑being. Our...Insurance claimsPermanent employmentContract workWork experience placementWork at officeRemote work- Business Analyst - Insurance Operations - REMOTE Join to apply for the Business Analyst - Insurance... ...such as underwriting, accounting, compliance, audit, information technology, etc. Translate... ...OF BECOMING A WAHVE VINTAGE EXPERT Health insurance based on eligibility. 401(k)...Health InsuranceRemote jobFull timePart timeWork experience placementWork at officeWork from home
- ...comprehensive training, all required compliance certifications, and ongoing... ...practices, managing insurance claims, patient billing, eligibility... ...claim denials and initiate appeals with insurance companies.... ...regulations for all patient health information handling. Maintain...Health InsuranceInsurance claimsRemote workWork from homeFlexible hours
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