Senior Configuration Oversight Lead for Claims & Audits
Molina Healthcare
Molina Healthcare is seeking a lead-level analyst to support configuration oversight for claims and provider databases, ensuring accurate data and adherence to state/federal requirements. The role involves auditing, reporting, and guiding implementation across the SDLC to optimize claims processing. The ideal candidate has 5+ years of claims auditing experience, strong SQL/PowerBI skills, and deep knowledge of provider contracting, network management, and benefits related to audits. #J-18808-Ljbffr Molina Healthcare
$59.81k - $129.59k
...DESCRIPTION Job Summary Provides lead level analyst support for configuration oversight activities. Responsible for accurate... ...of critical information on claims/provider databases, validating data... ...accuracy. Facilitates end-to-end claim audits, maintains audit records,...ClaimsWork experience placementWork at office- Starr Insurance Companies in the United States seeks a Senior Claims Analyst/Manager for Commercial Auto with oversight of TPAs and complex claims. You will monitor systems, analyze loss trends, and coordinate with underwriting to manage exposures and fees. Travel is required...SeniorClaims
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...this role ends on 09/30/2026. As a Senior Consultant and ServiceNow Platform Lead within our Finance Transformation... ...workflows, integrations, and configurations.Design and implement workflow orchestration... ..., and technical decisions for audit readiness and operational...SeniorLocal areaVisa sponsorship- MGM Resorts International is seeking a Senior Claims Analyst to lead investigations of complex third-party claims in a risk management setting. You will assess liability, damages, and settlements with professional judgment and guest-focused service. The role requires strong...SeniorClaims
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...Home, Ohio POSITION OVERVIEW Internal Audit is the third line of defense and is accountable... ...applicable laws and regulations. The Senior Lead Auditor within the Professional... ...leadership skills by leading or providing oversight on department initiatives and projects....SeniorWork at officeRemote workWork from homeFlexible hours- ...is seeking an experienced Facets consultant to lead implementations and advise on enrollment, billing, claims, and COB. The role requires deep product knowledge... ...with clients, while guiding architecture and configuration decisions. The remote role involves managing mid...SeniorClaimsRemote job
- Kingsgate Logistics, LLC is building a dedicated LTL desk in West Chester, United States. You will lead carrier relationships, pricing, audits, and claims, with the goal of growing the LTL book from $8M to beyond $15M. You will own the desk operations, negotiate CSPs and...Claims
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...systems and Marts. You will lead and coordinate work related to... ...detail data is appropriately auditable, snapshotted, and stored for... ...implementation. Provide detailed configuration expertise to customers and... ...years' experience with medical claims, Pharmacy/medical rebate data...Claims$176.72k - $265.08k
...focused Tax Reclaim Transformation Technology Lead the end-to-end digitization and automation... ...and documentation management through claim submission, tracking, and recovery reconciliation... ..., and recovery reconciliation — with full audit trail and client reporting.Regulatory...SeniorClaimsFull time- Nestlé Health Science is seeking a Senior Regulatory and Scientific Affairs Specialist (Remote) to drive regulatory compliance... ...cross-functional teams on recipe compliance, labeling, claims substantiation, and auditing, while maintaining systems and databases. The role...ClaimsRemote job
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- ...Current Senior Application Specialist The Department of Social Services (DSS) is comprised... ..., revenue producing computer matches, claiming systems, and personnel systems.... ...processed for clients. - Perform remote configuration, setup and installation of IT hardware,...SeniorClaimsWork at officeRemote workShift work
$65 - $95 per hour
Exciting Opportunity: Senior R&D Tax Credit Consultant (Enrolled Agent... ...helping innovative businesses claim valuable R&D tax credits that... ...(and expectation) to lead the R&D function. Key responsibilities... ...claims for accuracy and audit readiness Supporting and preferably...SeniorClaimsHourly payFor contractorsRemote work- NIIC National Interstate Insurance Company in Richfield, OH, is seeking a Senior Claims Representative for Bodily Injury to join our team on a hybrid schedule. The role requires handling bodily injury claims, conducting investigations, and negotiating settlements within...SeniorClaims
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...opportunity EY’s Forensics Insurance and Federal Claims Services practice specializes in helping... ..., fires, tornadoes, and pandemics. As a leading professional services firm, we offer... ...field 9+ years’ related compliance, audit, financial management, disaster recovery...SeniorClaimsSummer holidayWork at officeLocal areaFlexible hours- A leading commercial insurance provider is seeking a Sr. Commercial Claims Manager to oversee the Non-Injury Claims Unit. The role includes strategic planning, team leadership, and ensuring compliance with insurance regulations. Candidates should have at least 5 years...SeniorClaimsRemote job
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...Healthcare Quality Assurance professional to support quality assurance, auditing, and financial operations within a healthcare environment. This... ...within Medicaid, Medicare, managed care, health insurance, claims, or government healthcare programs. One to two years of hands-...SeniorClaimsRemote jobFull timeWork at officeFlexible hours- ...and hands‑on Database & GIS Lead to build and lead this function... ..., laboratory data import configuration, and integration into the master... ...coordinate data imports, exports, audits, and reconciliations across... ...datasets including mineral claims, land ownership, drill holes,...ClaimsFor contractors
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- ...Senior.NET Full Stack Developer Senior.NET Full Stack Developer with strong authentication... ...for databases and software configurations by providing data access and permissions... ...to track existing applications, pending claims, and related items. Develop nightly batch...SeniorClaimsNight shift
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