Senior FWA Investigator, Healthcare Claims Analytics
$46.99k - $112.2kHispanic Alliance for Career Enhancement
The Hispanic Alliance for Career Enhancement is seeking a Sr. Analyst in Maryland to detect, investigate, and refer fraud, waste, and abuse incidents in healthcare services. This role requires 3-5 years' experience and coding expertise, focusing on compliance and billing accuracy. Qualified candidates should demonstrate strong analytical and collaborative skills. The position offers a full-time schedule with a competitive salary range of $46,988.00 - $112,200.00 and a comprehensive benefits package. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement
$46.99k - $122.4k
...in the United States is looking for a dedicated professional to manage complex health care fraud investigations. This full-time role involves preventing fraudulent claims, preparing cases for review, and cooperating with law enforcement. Applicants should have 3 years...SeniorClaimsFull time$67.9k - $199.14k
...an exciting opportunity for a Senior Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role, you will... ...analytics, interpreting large healthcare datasets, and translating... ...leveraging medical and pharmacy claims, encounter, provider, and membership...SeniorClaimsRemote jobHourly payFull timeTemporary workWork experience placementLocal area$46.99k - $122.4k
...groups in a prepayment environment Investigates to prevent payment of fraudulent claims committed by insured's,... ...investigation and prosecution of healthcare fraud and abuse matters. Demonstrates... ...Health fraud cases. Strong analytical and research skills using health...SeniorClaimsHourly payFull timeTemporary workLocal area- ...support a DHS project. This remote role involves designing and implementing AWS infrastructures, developing healthcare claims systems, and performing data analytics. Ideal candidates will possess a Bachelor's degree, U.S. Citizenship, and significant experience in...SeniorClaimsRemote job
$91.4k - $187k
...Oracle Health is transforming healthcare through intelligent,... ...seeking a highly motivated Senior Product Manager to lead product... .... ~ Experience using data, analytics, customer insights, and KPIs... ...Experience with prior authorization, claims management, eligibility...SeniorClaimsTemporary workWorldwideFlexible hours$18.5 - $42.35 per hour
A national healthcare organization is seeking a Medical Claims Specialist to review and adjudicate complex medical claims, ensuring compliance with established guidelines. Candidates should have at least 18 months of medical claim processing experience and the ability to...SeniorClaimsHourly payFull time- ...Stars Decision Science team, responsible for providing advanced analytics and decision frameworks to support Medicare Advantage members.... ..., possess strong analytical skills, and have experience in healthcare analytics. This position offers a remote work option but prefers...SeniorRemote job
- CVS Health is seeking a Senior Informatics Manager to join the Risk Adjustment Analytics team in Maryland. The role focuses on executing complex data analyses to... ...departments for strategic insights. With 8+ years of healthcare analytics experience, strong leadership...Senior
$90.31k - $135.46k
Dormont Manufacturing Co in Annapolis, Maryland is seeking an Analytics Team Member to enhance healthcare analytics. This role involves data analysis, report development, and effective communication with stakeholders. Candidates should have a BS in Computer Science or related...Senior- ...Position Summary The Compliance Senior Health Data Analyst is... ...responsible for providing advanced analytics, reporting, and data-driven... ...requests, audits, investigations, privacy incidents, and member requests for claims and healthcare information, ensuring the accurate...SeniorClaimsWork experience placement
- ...subject matter experts. Job Description: EEO Investigator - Defense Position Title: EEO... ...and procedures to assess the validity of claims. Documentation and Reporting: Prepare written... ...and policies. Strong investigative and analytical skills, with the ability to assess...ClaimsContract workRemote work
$23.16 - $35.88 per hour
Highmark Health seeks a Stop Loss Claims Analyst in Annapolis, Maryland. This role involves reviewing and processing various claims while... ...insurance claims experience, organizational skills, and strong analytical abilities. The position is office-based and includes...SeniorClaimsHourly payWork at office$80.9k - $110.3k
...Provider Hospital Reimbursement Analyst (Senior Business Systems Analysis Professional)... ..., the pricing software vendor, CIS BSS, claims operations, and other business teams involved... ...encourage personal wellness and smart healthcare decisions for you and your family while...SeniorClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$46.99k - $112.2k
...Fraud, Waste, and Abuse (FWA) will assist in detecting, investigating, remediating and... ...transportation, and other healthcare services. The Sr. Analyst... ...correct coding, review claims, and billing data from all... ...Responsibilities Leverage analytical skills to review claims...SeniorClaimsHourly payFull timeTemporary workWork experience placementLocal area$67.9k - $199.14k
...workforce management expert to optimize claims operations. This role involves forecasting... ...optimization. Collaborating with senior leadership, you'll drive process improvements... ...experience in workforce management and strong analytical skills. The position offers a...SeniorClaims- Ensures the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with...ClaimsWork experience placement
- Sedgwick in Annapolis, MD seeks an experienced Claims Manager to analyze and determine benefits due for complex liability claims. This... ...in claims management along with strong interpersonal and analytical skills. A comprehensive benefits package is offered, including...SeniorClaims
- ...candidate will have a Juris Doctorate, a minimum of 5 years in the field, and exceptional analytical and negotiation skills. Responsibilities include representing clients in claims, conducting legal research, and drafting necessary documents. The firm values...SeniorClaimsPermanent employment
$18.5 - $42.35 per hour
CVS Health in Maryland seeks a Senior Coordinator for their Minute Clinic Accounts Receivable. This full-time position involves managing medical claims, ensuring compliance, and implementing process efficiencies. The ideal candidate will have a solid background in medical...SeniorClaimsHourly payFull time- 6AM City, LLC is seeking a Senior Closeout Specialist in Maryland. The role involves reviewing specialized contracts, providing contract... ...contract closeouts. Responsibilities include preparing closeout documentation and negotiating claims as needed. #J-18808-Ljbffr...SeniorClaimsContract work
$23.16 per hour
...Stop Loss (Excess Risk and Reinsurance) claims in accordance with established... ...claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which... ...work independently. Problem Solving and analytical skills. Language (Other than English):...SeniorClaimsFor contractorsWork at officeLocal area$146.58k - $229.6k
...customer‑obsessed and results‑oriented Senior Product Manager for the AI Agent Platform... ...and domain experts from sales, service, claims, billing, and other lines of business. You... ...and non‑technical audiences. Proven analytical and problem‑solving abilities with a data...SeniorClaimsLocal area$46.99k - $122.4k
Position Summary The Senior Business Analyst supports execution and... ...follow‑up needs Data & Analytical Expectations Maintain working... ...operations, compliance operations, or healthcare operations Strong Excel,... ...with medical and/or pharmacy claims data Education Bachelor's...SeniorClaimsRemote jobFull timeLocal area- ...are Verantos customers. As a Senior Clinical Informaticist , you... ...implementation, transforming complex healthcare data into research-grade... ...Semantic normalization Map claims data and health system data... ..., CPT, HCPCS). Demonstrated analytical and problem-solving skills applied...SeniorClaims
- ...Support Conduct thorough and objective investigations into employee relations matters and workplace... ...Analysis & Cost Management Analyze claims data, utilization reports, and trend... ...respect, and professionalism. Excellent analytical and problem-solving skills with the ability...SeniorClaimsTemporary workFor contractorsWork at officeLocal areaImmediate start
$80k - $95k
Senior Account Manager - Commercial Lines Hybrid Preferred: 1-2 days in Columbia, SC office... ..., policy administration, billing, claims, and coverage analysis. Manage policy expirations... ...equivalent) strongly preferred. Strong analytical, problem‑solving, and decision‑making...SeniorClaimsFor contractorsRemote work- A healthcare services organization in Annapolis is seeking a PAVE Coordinator. This role involves... ...Pre-Authorization requests for claims that require approval and necessitates effective... ...procedures, and demonstrate excellent analytical and communication skills. The position...Claims
$135k - $216k
...Health Solutions team, Benefits, Claims & Integrity Solutions... ...initiatives. As a trusted advisor to senior leadership, the Policy... ...’s mission areas. Excellent analytical, communication, and senior‑level... ...modernization initiatives. ACA or healthcare/insurance specific policy...SeniorClaimsContract workFor contractorsShift work$87.6k - $144.55k
...ProAssurance specializes in healthcare professional liability, products... ...This position supports the Senior Living/Long-Term Care segment... ...disciplines including Actuarial, Claims, and Risk. Adhere to Letter... ...communication skills. Analytical ability, to gather data and interpret...SeniorClaimsWork at officeRemote work$81.7k - $135k
...Tax - Sales and Use Lookback Review COE - Senior Will you shape the future or will... ...Prepare and defend sales and use tax refund claims Participation on a motivated team of... ...for We seek top performers who are analytical, adaptable, and proactive individuals...SeniorClaimsSummer holidayImmediate startFlexible hours
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