Medicaid Systems Lead — Policy, Claims & Analysis
Conduent, Inc.
Conduent is seeking a Senior Medicaid Technical Business Analysis Engineer with deep Medicaid operations, policy, and claims processing experience. You will work across business and technical teams to translate regulatory requirements into system solutions and drive improvements in efficiency and compliance. In this role you will analyze data, support UAT, and develop test strategies while maintaining strong communication with stakeholders and ensuring alignment throughout the project lifecycle. #J-18808-Ljbffr Conduent, Inc.
$50k - $62k
Lead client outcomes, develop talent, and... ...requirements, company policies, regulatory... ...working with Medicare, Medicaid, and commercial... ...understanding of claims lifecycle management... ...perform root-cause analysis, and improve... ...cycle management systems, reporting tools,...PolicyClaimsHourly payWork at officeRemote workFlexible hours$60k - $75k
Medicaid Drug Rebate Supervisor Job Description... ...Supervisor to lead a team of rebate professionals... ...Excel and data analysis tools. Experience... ...administration systems, MMIS platforms,... ...of pharmacy claims processing, NDCs,... ...ADAAA Accommodation Policy. At Conduent we value...PolicyClaimsContract workCasual workRemote workWork from homeMonday to FridayFlexible hoursAfternoon shift$150k - $200k
...Fractal. Role Overview Lead Architect - Ontology, AI,... ...insurance concepts such as policies, claims, coverages, parties, products... ...frameworks covering intent analysis, planning, tool selection, context... ...of multi-agent systems and multi-agent orchestration...PolicyClaimsHourly payFull timeLocal area$40.85k - $88.51k
Sr Analyst, Claims Research (Medicaid Claims) Remote United States Trending... ...to perform root-cause analysis, and resolve issues through system corrections, manual... ...applicable state specific policies and regulations to... ...operational claims fixes. Leads and manages complex...PolicyClaimsRemote jobFull timeTemporary workWork experience placementWork at office- Mission The US healthcare system is complex, error‑prone... ..., Granted can fight claim denials, correct billing... ...like: strategic bill analysis and pattern‑finding (~4... ..., financial assistance policies, No Surprises Act protections... ...Experience training or leading a team of billers,...PolicyClaimsWork experience placementWork at officeRemote workMonday to FridayMonday to ThursdayShift work
$40 - $50 per hour
...Healthcare Business Analyst / Systems Analyst position for... ...related to claims processing, provider enrollment... ...enrollment, eligibility, and Medicaid program operations. Conduct CA-MMIS OIL analysis, requirements... ...mainframe tables, files, policy updates, and related system...PolicyClaimsLocal areaRemote work$66k - $106k
...galaxy. As the world's leading mission capability... ...Overview Performs data analysis, investigation, and medical... ...abuse in Medicare and Medicaid programs. About The... ...broadly defined policies and practices to determine... ...Experience in reviewing claims, performing medical...PolicyClaimsContract workTemporary workFor contractorsWork at officeRemote workShift workNight shift$45.18k - $75.3k
...the Opportunity: As a Lead Recordkeeper, you will... ...primary focus on death claim processing. This role requires... .... Utilize internal systems and available resources... ...with company policies, client requirements, and... ..., including adjustment analysis, balancing activities,...PolicyClaimsPart timeWork experience placementLocal areaFlexible hours$70k - $85k
...decision we make. As the Team Lead, Billing & Collections, you... ...Engineering, and the Business Systems Analyst on Zuora and billing... ...installment invoices, short‑rated policies, claim deductibles, audit surcharge... ...year of experience with data analysis and an understanding of...PolicyClaimsWork experience placementRemote work$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer... ...support of proactive data analysis efforts. In addition,... ...Integrity System's objective: To provide... ...contained in Standard Claims Processing System files... ...Medicare or Medicaid payment policies Utilizes extensive knowledge...PolicyClaimsFor contractorsH2bH1bWork at officeLocal areaRemote workHome office- Lead Insurance Specialist, Recovery Services Employee Working... ...insurance documentation, policy limitations, claim decisions, payouts, exclusions... ...eligibility, or additional analysis is required to support non-... ...interactions in Red Cross systems. Develop, maintain, and...PolicyClaimsPermanent employmentFull timeTemporary workWork at officeWork from homeHome office
$81.2k - $105.45k
Senior Medicaid Technical Business Analysis Engineer Join Our Team: Conduent is seeking a Senior Medicaid... ...background in Medicaid operations, policy, and claims processing. This role is ideal for... ...requirements into effective system solutions. As a key member of our...PolicyClaimsWork at officeRemote workWork from homeFlexible hours$140k - $190k
...technology. Our in-house Agency Management System gives our team and AI agents full visibility into policies, exposures, claims, billing, and commissions. This platform enables... ..., Compound). We have raised over $43M from leading investors including Sequoia, 8VC, Khosla...PolicyClaimsFull timeFor contractorsWork at officeWork visaFlexible hours$128k - $160k
...fragmented, outdated systems with the industry's first Unified Claims Processing™... ...Americans and proudly leading the next generation... ...and reimbursement policies. This role can... ...Exception Handling, Analysis & Reporting Review... ...Medicare, or Medicaid provider reimbursement...PolicyClaimsDaily paidContract workInterim roleLocal areaFlexible hours3 days per week$136k - $180k
...outbound data flows for downstream systems (Oracle FDI) Data... ...Data validation Variance analysis Intercompany reconciliation... ...dignity, today we're a market-leading retirement company fueled by... ...Email: Drug and Smoking Policy TIAA maintains a drug-free...PolicyWork experience placementWork at office$99k - $232k
...a Guidewire Configuration Lead you will apply consulting skills... ...efficiency through analysis, software implementation, training... ...deliverables, identifying system dependencies, and resolving... ...leadership across policy, billing, or claims- Leading complex project planning...PolicyClaimsFull timeH1b$29.9 - $51.35 per hour
...Lead Healthcare Claims Assistant Location: New York or Chicago Work Schedule... ..., and other departmental systems. Draft, prepare, and... ...adherence to company claims policies and procedures. Assist in... ...studies, or workflow analysis. Perform other general clerical...PolicyClaimsFull timeWork experience placementWork at officeLocal areaImmediate start$74.2k - $128.5k
...Reporting to the Absence Claims Director, the Absence... ...& Development Directly lead a team of Absence Claim... ...communication as processes, systems, technology, or clients... .... Lead root cause analysis and develop action plans... ...best interests of our policy owners. To learn more about...PolicyClaimsTemporary workLocal areaRemote work- ...for processing and disputing chargeback claims, identifying potential fraudulent activity... ...ParkNYC, garages, and other parking payment systems. Research transactions and gather... ...Assist with planning activities and recommend policy and procedural improvements to enhance...PolicyClaimsWork at office
- ...ll do: The Billing Team Lead is responsible for... ...while ensuring accurate claim submission, timely reimbursement... ...claims to Medicare, Medicaid, commercial insurance... ...billing accuracy and policy adherence. Assist with... ...accurately into the collection system. Attending quarterly...PolicyClaimsWork at officeRemote workMonday to Friday
$72.7k
JOB SUMMARY Seeking a Quality Lead with strong data-testing leadership... ...expertise Understand claims, membership, provider, and care... ...defect management, and root cause analysis. Delivery leadership Drive... ...business conduct and company policies. As a component of job responsibilities...PolicyClaimsFor contractorsLocal areaRemote work- ...Supplemental Products Team Lead (Health Insurance) Join... ...the management, analysis, and optimization of supplemental... ...products insurance claims to ensure that claims... ...with plan documents, policies, and industry regulations... ...of data between claims systems, eligibility feeds, and...PolicyClaimsFull timeWork at officeRemote workWork from homeHome office
- ...REQUIREMENT SUMMARY - Role: Lead Palo Alto Networks... ..., risk assessment, policy development, integration... ...ITSM and other authorized systems Analyze device and... .... Automation and data analysis: Use of APIs, PowerShell... ...; copies required if claimed. WHAT TO SUBMIT -...PolicyClaimsHourly payRemote work2 days per week
$124k - $233k
...Type: EmployeeLead Specialty Claims (Aviation)Location: USA - Plano... ...market claims in alignment with lead market recommendations, claims... ...(s), aviation insurance policies, and regulatory requirements.... ...forecast of Claims activity through analysis of business levels and...PolicyClaimsFull timePart timeWork experience placementWork from home$55k - $75k
...company feel! In this role, the Medicaid Auditor will be responsible... ...appropriateness, program and policy compliance, billing, coding... ..., as well as research and analysis of industry trends. Job Responsibilities... .... Experience in reviewing claims for appropriate billing and...PolicyClaimsRemote jobFull timeContract workTemporary workFor contractorsWork at officeLocal areaFlexible hours$131k - $212k
...LinkedIn's B2B Institute is a leading think tank shaping the future... ....Lead secondary research and analysis, evaluate findings, test... ...standards, ensuring published claims are supported by credible research... ...records.Pay Transparency Policy Statement As a federal contractor...PolicyClaimsFor contractorsWork at officeFlexible hours- ...established and market-leading brand serving a... ...account, client system and provides high... ...regarding billing policies, state guidelines, reimbursement analysis and assists with resolution... ...accounts and claims Maintains a... ...knowledge of Medicare, Medicaid, Private Insurance...PolicyClaimsFull timeWork at office
$140k - $160k
...Antal/LOEPMHBSAUSA/97644Job Title: Lead Oracle EPM / Hyperion Business Systems Analyst - USAIndustry: Financial... ...and Oracle EPM with strong business analysis capabilities, project leadership... ...development benefits, subject to employer policies.Additional InformationThis...PolicyWork at office- ...Technologies is seeking a Systems Analyst for a position... ...provides systems analysis, systems administration... ...create/submit warranty claims to vendors, including developing... ...where FAA security policy deviates. Conduct... ...exceed expectations and lead the industry in...PolicyClaimsContract workTemporary workFor contractorsWork at officeLocal area
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