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
...Job Summary Provides lead level analyst support for configuration information management activities. Responsible for accurate and... ...maintenance of critical information on claims databases, synchronizing... ...data and application of business rules as they apply to each database,...ClaimsWork experience placementWork at officeRemote work$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- ...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
- ...SCAN is seeking a Program Lead for QNXT Implementation to oversee the claims workstream transformation. This role involves planning, executing, and ensuring quality deliverables for claims migration. The ideal candidate will have at least 6 years of experience in healthcare...ClaimsTemporary workRemote 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$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- ...Lead Analyst, Quality Analytics and Performance Improvement The Lead Analyst... ...Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates.... ...business environment to derive meaningful information out of complex as well as large...ClaimsWork at officeRemote work
$34.47 - $49.97 per hour
## Product Manager, QNXT Implementation - SCAN... ...for the Claims workstream as part... ...Provider Data, and Configuration, including provider... ...benefits, UM/business rules, and capitation, as... ...well as the program lead and subject matter... ...Administration, Information Systems, or related...ClaimsHourly payTemporary workWork at officeRemote work$21 - $29 per hour
...products and services. Assists management with the supervision of... ...procedures by properly handling claims and returns; zoning the area;... ...partners; analyzing and applying information from multiple sources;... ...compliance issues and problems. Leads and participates in teams by...ClaimsHourly payMinimum wageFull timeTemporary workPart time$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- ...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
- ...Lead Oracle HCM Cloud Functional Principal Consultant - Absence/Time & Labor Work location: Remote - West Coast... ...and interpret business requirements to appropriate configurations of the Absence Management & OTL modules. Lead the testing events associated with the...Local areaRemote work
$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$16.4 - $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- ...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
- ...eligibility, benefits, claims, and provider data... ...codes, payer‑specific rules, and transaction‑level... ..., and clearinghouse configurations. Lead requirement‑gathering... ...Healthcare Administration, Information Systems, Business, or... ...U.S.-based teams and managing business discussions...Claims
- ...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
- ...salary Paid time off You May Be a Great Fit as an Agency Manager at Jody Parker - State Farm Agent if: You take ownership and... ...care, and real support. Whether we’re helping someone navigate a claim or personalize a plan, we believe in doing meaningful work that...ClaimsWork at office
- ...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
$30 - $50 per hour
...Lead Harnessing Technician Cypress, California, United States At Senra Systems... ...manufacturing lies not in automation, but in configuration. We supercharge electrical wire... ...Proficiency with ERP/MRP systems, work order management, and BOM structures. Excellent...Hourly payPermanent employmentContract workWork at officeLocal areaFlexible hoursWeekend work- ...size dental service organization, strong knowledge of Medi-Cal billing, and proven leadership skills. Key responsibilities include managing the billing team, ensuring compliance with insurance guidelines, and communicating with patients regarding their financial...Claims
- ...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
- ...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
- ...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
$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- ..._______________ 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
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