Lead Configuration Information Management - Claims & Rules
Molina Healthcare of Illinois
Molina Healthcare is seeking a Lead Analyst for configuration information management in Long Beach, California. This role involves analyzing data, managing coding and benefit plans, and collaborating with stakeholders to meet business objectives. The ideal candidate has over 5 years in health care operations, advanced experience with claims processing systems, and strong analytical and communication skills. Competitive benefits and compensation are offered. #J-18808-Ljbffr
$59.81k - $129.59k
...DESCRIPTION Job Summary Provides lead level analyst support for configuration information management activities. Responsible for... ...of critical information on claims databases, synchronizing operational... ...and application of business rules as they apply to each database,...ClaimsWork experience placementWork at office$51.06 - $73.9 per hour
...Program Lead, QNXT Implementation - SCAN... ...implementation of the Claims workstream within... ...product managers for Claims, Provider Data, and Configuration (including provider... ...benefits, UM/business rules, and capitation),... ...Health Administration, Information Systems, or...ClaimsHourly payTemporary workWork at officeRemote work- ...Lead Analyst The Lead Analyst serves as a data steward with deep... ...healthcare data (eligibility, claims, auths etc.) Acts as the... ...business definitions, data logic and rules. Apply deep subject matter... ..., and strategic decisions to Manager/Director. Operates...ClaimsRemote work
- ...Job Title Provides lead level analyst support for health... ...(PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute... ...integrity (PI) solutions. Manages scorable action items (SAIs... .../state Medicaid payment rules. Strong data analysis/queries...ClaimsTemporary workWork at officeRemote work
$14.76 - $31.97 per hour
...JOB DESCRIPTION Job Summary Provides lead level support for core operations activities including claims processing, benefit interpretation, provider services,... ...compliance. Essential Job Duties Effectively manages escalations within the department by ensuring...ClaimsHourly payWork experience placementWork at office$49.43k - $107.1k
...maintenance of critical provider information on all claims and provider databases.... ...application of business rules as they apply to each... ...pertains to contracting, network management and credentialing.... ...feedback. Assists in complex configuration issues and loading of...ClaimsWork experience placementWork at office$95 per hour
...Consulting is seeking an experienced IT Project Manager for a contract role focused on implementing a core claims processing platform. The ideal candidate has over... ...expert in claims platforms. Responsibilities include leading the technical implementation, managing vendor...ClaimsContract workRemote work- ...Summary The Provider Configuration Supervisor is responsible for leading and overseeing all... ...within the claims adjudication system... ...and claims payment rules are configured... ...and amendments. Manage retroactive configuration... ..., Finance, Information Systems, or related...ClaimsContract workFlexible hours
$60k
...button and follow the next steps. As a claims specialist on our team, you'll play a... ...and others involved in the accident. The information gathered will then be used while determining... ...task and prioritize Knowledge of the rules of civil procedures in terms of filing/...ClaimsWork experience placementWork at office$51.06 - $73.9 per hour
...Senior Manager Payment Integrity SCAN began... ...functional system configuration team which... ..., Authorizations, Claims, Encounters, Member... ...You Will Leads the coordination,... ...retired configuration rules, the source of the... ..., and summarizing information and trends. Attends...ClaimsHourly payTemporary workWork at officeRemote work$34.47 - $49.97 per hour
...Product Manager, QNXT Implementation - SCAN... ...approaches for the Claims workstream as part... ...Provider Data, and Configuration, including... ...benefits, UM/business rules, and capitation, as... ...well as the program lead and subject matter... ...Health Administration, Information Systems, or...ClaimsHourly payTemporary workWork at officeRemote work$106.2k - $182.98k
...alignment, and solution design across Care Management, Utilization Management, Pharmacy,... ...measurable improvements in member outcomes. Lead cross functional discovery and... ...across CCD/C‑CDA, ADT, labs, pharmacy, and claims with strong FHIR/HL7/X12 skills and coding...ClaimsWork experience placement$120k - $130k
...an Oracle Fusion Functional Lead - SCM & Finance to provide hands... ..., and production support. Configuration and development work is... ...Oracle Fusion Module Coverage information below) - Develop a strong... ...inventory, procurement, and order management - Translate business...3 days per week$68k - $74k
...Description Role Overview Chili's Managers are wired for hospitality! We're in the... ...know how to have fun along the way. From leading the team through a high-energy shift to... ...Texas in 1975. Since then, we've boldly claimed our place in the casual dining industry...ClaimsCasual workShift work$14.76 - $31.97 per hour
...Summary Provides support for claims activities including... ...findings accordingly (includes information on trends as requested).... ..., fee schedules and systems configurations, to determine root causes of... ...Qualifications At least 2 years of managed care experience in a call...ClaimsHourly payContract workWork experience placementWork at office$30 - $50 per hour
...manufacturing lies not in automation, but in configuration. We supercharge electrical wire... ...builds at record-breaking speed. As a Lead Technician, you will be the 1st line of... ...Proficiency with ERP/MRP systems, work order management, and BOM structures. Excellent...Hourly payPermanent employmentContract workWork at officeLocal areaFlexible hoursWeekend work$135.15k - $182.85k
...Payloads Engineer (Senior or Lead) Company: The Boeing... ...to completion, leading risk management, assessing scope changes and... ...to certification or to configuration control, and by defining overall... ...Present engineering technical information in customer and supplier...Permanent employmentWork experience placementRelocationVisa sponsorshipWork visaFlexible hoursShift work- ...Title Provides analyst support for configuration oversight activities. Responsible for... ...and maintenance of critical information on claims/provider databases, validating data housed... ...pertains to provider contracting, network management, credentialing, benefits, prior...ClaimsWork at officeRemote work
- ...prominent insurance brokerage is seeking a Vice President of Bill Review and Managed Care to oversee medical cost containment programs. This role requires a Bachelor's degree and extensive claims management experience, preferably over 10 years, along with an active...ClaimsRemote work
- ...A leading claims adjusting firm is seeking Independent Insurance Claims Adjusters in California. This opportunity involves assisting clients through the claims process after disasters. Ideal candidates will be licensed adjusters with experience handling multiple claims...Claims
- ...Job Description: Must have skills: QNXT - Claims, QNXT-Membership and QNXT Provider - 4... ...Membership, Claims, Billing etc) Needed. Configuration experience in QNXT is added advantage... ...Azure Cloud would be added advantage Lead Skills: Playing team lead role...Claims
- ...Job Description POSITION SUMMARY The Configuration Analyst I will be responsible for... ...programmed accurately for Authorizations and Claims. RESPONSIBILITIES-DUTIES Configure... ...Supervisor of Contract Configuration or Manager of Contract Configuration. Ability to...ClaimsContract workWork at officeFlexible hours
- ...assemblies prior to assembly to obtain required configurations or positions for welding, using... ...identity, gender expression, genetic information, physical or mental disability, military... ...established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 668; 43 U.S.C....ClaimsContract workShift work
$96.05k - $129.95k
...Manufacturing Engineer (Experienced and Lead Level) Company: The Boeing... ...~4 + years' experience in Production Configuration Management. ~4 + years' experience in a Manufacturing... ...policies. General: All information provided will be checked and may be...Permanent employmentWork experience placementCurrently hiringImmediate startRelocationVisa sponsorshipWork visaRelocation packageFlexible hoursShift work- ...Independent Insurance Claims Adjusters Needed Now Is it time for a career change? Independent insurance claims adjusters are needed now! Are you ready to embark on a dynamic and in-demand career as an independent insurance claims adjuster? This is your chance to join...Claims
- ...analysis of complex healthcare claims data, pharmacy data, and... ...utilization and cost containment information. Evaluates, writes, and... ...solutions while overseeing and managing the activities of assigned... ...Claims, Utilization Management. Configuration and Payment Integrity to...ClaimsContract workRemote work
- ..._______________ Manager is looking for a candidate... ...that can support AP Claims, CRM, and a bit of UM.... ...at least 6 years of configuration experience. Demonstrate proficiency with information systems technology, which... ...Bhupesh Khurana Lead Technical Recruiter...ClaimsTemporary workWork at officeLocal areaRemote work
$23 per hour
...a full-time Community Manager position. Compensation... ...and properly direct claims, incident reports and assist... ...and accurate safety information manuals, provide all residents... ...and follow posted work rules and procedures.... ...criticism. Ability to lead and manage others....ClaimsHourly payFull timeContract workFor contractorsImmediate startFlexible hours$34.47 - $49.87 per hour
...Job The Senior Configurations Specialist QNXT - SCAN... ...knowledge sharing. Will lead initiatives to improve... ...for IKA & QNXT claims processing improvement... ...owners and Shared Services Management. Maintain accurate... ...proposed changes, making informed recommendations, and...ClaimsHourly payTemporary workFor contractorsWork at officeRemote work- ...serve as our Senior Director of MSO – Claims Operations & Provider Configuration. This position requires candidates... ...market expansion Performance Management & Operational Improvement Improve... ...underpayment, and compliance risk Lead audit readiness for CMS and health...ClaimsContract workFlexible hours
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