Senior Payment Integrity & Claims Analytics Lead
Jobtailor
Jobtailor seeks a lead-level analyst to drive payment integrity operations for health plans in California. You will QA junior analysts, lead vendor reporting, and collaborate on strategies to improve financial performance and cost containment. The role requires five years of experience in payment integrity, claims auditing, or medical coding, with strong SQL and data visualization skills. Bachelor’s degree or equivalent experience is preferred. #J-18808-Ljbffr Jobtailor
- IEHP in Rancho Cucamonga is seeking a Senior Payment Integrity Analyst to lead daily PI operations, audits, and reporting. The role includes mentoring... ...compliance, with a focus on payment integrity and provider claims accuracy. Responsibilities include data mining with SQL...SeniorClaimsRemote job
- Inland Empire Health Plans (IEHP) seeks a Senior Payment Integrity Program Development Specialist to lead research, analysis, and development of initiatives that... ...regulatory compliance. You will evaluate cost trends, claims patterns, and industry developments, managing a...SeniorClaims
- Inland Empire Health Plans (IEHP) is seeking a Senior Payment Integrity Analyst to lead a team of analysts and oversee daily operations of payment integrity... ...initiatives. You will ensure accuracy of provider claims and drive cost avoidance through remediation plans. Reporting...SeniorClaimsDaily paid
- Provide lead-level analyst support for daily operations of payment integrity vendors and internal programs Perform quality assurance... ...integrity and provider claims accuracy initiatives Make recommendations... ...system configurations Strong analytical skills with the ability to...SeniorClaimsDaily paidContract workWork experience placement
- ...! Reporting to the Manager, Payment Integrity Operations, the Senior Payment Integrity Analyst provides lead level analyst support to a team... ...integrity (PI) and provider claims accuracy. The Senior Payment... ...with IT and vendors Strong analytical skills with the ability to...SeniorClaimsContract workTemporary workWork experience placementFlexible hours
- ...experience! Reporting to the Manager of Payment Integrity Program Development, the Senior Payment Integrity Program... ...role evaluates medical cost trends, claims patterns, and industry... ...mining. Experience in complex claims analytics and trend evaluation Bachelor’s...SeniorClaimsDaily paidTemporary workWork experience placementFlexible hours
- Inland Empire Health Plan (IEHP) is seeking a Senior Payment Integrity Program Development Specialist in Rancho Cucamonga, CA. The role drives research... ...into actionable outcomes, enhance FWA detection, and lead cost-avoidance strategies across operations. #J-18808-Ljbffr...SeniorRemote job
- ...Empire Health Plans (IEHP) invites you to join our Payment Integrity Enablement team as Manager, leading education, provider guidance, and compliance initiatives... ...governance, and training delivery, collaborate with Claims, Compliance, and SIU/FWA, and drive measurable...Claims
- IEHP in Rancho Cucamonga is seeking a Payment Integrity Analyst to use data analytics and regulatory expertise in monitoring overpayment inventory. This role involves collaborating with various teams to identify discrepancies and implement solutions to enhance payment accuracy...Claims
- Inland Empire Health Plans is seeking a Payment Integrity Analyst in Rancho Cucamonga to monitor overpayment inventories and analyze claims, coding, contracts, and clinical documentation... ...remediation actions while using data analytics, audit methodologies, and regulatory...Claims
- ...moderate-to-complex data mining leads, claim inventories, and audit... ...identifications Utilize AI, predictive analytics, and SQL to identify... ...reduce recurring improper payment trends Collaborate with clinical... ...understanding of payment integrity concepts, including pre-pay...ClaimsContract workWork experience placementWork at office
- ...experience! Reporting to the Manager, Payment Integrity Operations, the Payment Integrity Analyst... ...inventory and performs analysis of claims, coding, contracts, and clinical documentation... ...actions. This position leverages data analytics, audit methodologies, and regulatory...ClaimsContract workTemporary workWork experience placementWork at officeFlexible hours
- Inland Empire Health Plan (IEHP) in Rancho Cucamonga, CA seeks a Manager to lead enterprise-wide Payment Integrity Enablement training focused on coding accuracy, claim edits, and compliance with state and federal guidelines. You will oversee curriculum design, governance...Claims
$104.04k - $137.84k
...experience! Reporting to the Director of Payment Integrity, the Manager, Payment Integrity... ...position collaborates cross‑functionally with Claims, Provider Relations, Compliance, and... ...policies for diverse audiences Strong analytical, problem‑solving, and compliance monitoring...ClaimsTemporary workWork at officeFlexible hours- Jobtailor is seeking a Health Plan Claims Auditor to independently investigate data mining leads, claim errors, and overpayments. You will develop remediation actions, apply CPT/ICD-10 coding, and ensure accurate reimbursement by interpreting contracts and paying guidelines...Claims
- Inland Empire Health Plans (IEHP) seeks an Analyst III to lead cross-functional, advanced analytics supporting strategic and operational goals. You will translate complex data into actionable plans, deliver executive-level recommendations, and guide implementation across...Senior
- ...monitoring, Estimating, Risk Analysis, Claims avoidance and Mitigation, Change... ...We shall provide our services with integrity and stellar professionalism and... ...Role We are seeking an experienced Senior Data Engineering & Analytics Lead to drive data strategy, build scalable...SeniorClaimsWork at officeRemote work
- IEHP is seeking a Manager of Payment Integrity Enablement in Rancho Cucamonga. This role involves strategic leadership in payment accuracy education and compliance interventions. The ideal candidate must have 7+ years of experience, a relevant bachelor’s degree, and certifications...
- Origence is seeking a Financial Analyst, FP&A to support financial planning, reporting, business intelligence, and analytics initiatives across the organization. You will partner with FP&A and cross‑functional teams to deliver insights, build financial models, and drive...Senior
$100k - $140k
A healthcare technology company is looking for a Senior UM & Claims Manager in Chino, CA, to oversee Utilization Management and Claims operations. You will manage a team and ensure regulatory compliance while working with health plans. Ideal candidates have over 10 years...SeniorClaims$67k - $110.6k
...Total Loss Supervisor, the Senior Total Loss Adjuster... ...customers concerning the claim handling process and... ...losses. Work on and/or lead special projects as requested... ...decision making and analytical skills, strong... ...values innovation and integrity. Play a pivotal role in...SeniorClaimsFull timeWork experience placement$61.05k - $98.33k
...The Senior Liability Claims Specialist manages mid to complex Auto and/or General... ...reserves and authorizes payments within reserving authority... ...roles (I, II, III, Senior, Lead, etc.) new hires may be slotted... ...the most innovative and integrated solutions to our clients. We...SeniorClaimsMinimum wageFull timeWork at officeLocal areaRemote workFlexible hours$67k - $110.6k
...A leading insurance provider is seeking a Senior Total Loss Adjuster in Riverside, CA. You will be responsible for resolving total loss claims efficiently, providing customer support and ensuring compliance... ...Loss experience, excellent analytical and interpersonal skills, and...SeniorClaimsFull time- ...driving their role for shared success. The Senior Lead Auditor is responsible for planning,... ...control environments. Utilize data analytics and technology-enabled audit techniques... ...a dynamic environment. High degree of integrity, professionalism, confidentiality, and...SeniorWork experience placementWork at office
- ...Description POSITION SUMMARY The Senior Claims Adjuster is responsible for managing complex... ...Ensure that all claim determinations and payments are completed timely including but not... ...industry knowledge required Excellent analytical skills and verbal and written communication...SeniorClaimsWork at officeImmediate start
- ...Job Description Description: Claims Data Manager Aspire... ...Analyst, Business Intelligence, or Analytics role. ~ Strong SQL (T-SQL)... ...claims data to identify leakage, payment anomalies, fraud indicators,... ...teams to ensure data integrity and reporting reliability....ClaimsFull timeWork at officeRemote work
$100k - $140k
.... The Opportunity We are seeking a Senior UM & Claims Manager to lead and oversee Utilization Management and... ..., claims adjudication, payment processing, and reporting (ODAG logs... ...preferred) Exceptional organizational, analytical, and process improvement skills Strong...SeniorClaims$29.35 - $47.28 per hour
...Senior Claims Specialist The Senior Claims Specialist handles complex and high-profile Workers... ...Establishes reserves and authorizes payments within reserving authority limits Develops... ...For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a...SeniorClaimsHourly payMinimum wageFull timeLocal areaRemote workFlexible hours- ...degree of physical damage to vehicles for first and third party claims; complete detailed summary of damage and estimate cost of... ...solid foundation of personal organization, sound decision making, analytical skills, strong interpersonal and customer service skills. Inter...SeniorClaimsWork experience placementWork at office
- Description JOB SUMMARY The Team Lead serves as a subject matter expert and operational... ...Assist team members with claim handling, negotiations, valuation questions... ...and verbal communication skills. Strong analytical, organizational, and problem-solving abilities...ClaimsWork at office
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