Pega QA Tester: Healthcare Claims & Compliance
TechDigital Group
TechDigital Group in the United States seeks a Pega Tester to ensure quality, functionality, and regulatory compliance of Pega applications supporting healthcare claims processing, including Facets integration. You will create test plans, design test cases, execute manual testing, track defects, and collaborate with developers, business analysts and stakeholders to validate requirements and HIPAA/EDI standards. #J-18808-Ljbffr TechDigital Group
- ...Ace IT Careers is currently hiring motivated candidates for Remote Junior QA Tester opportunities supporting U.S.-based client projects across Healthcare, Banking, Telecom, and E-Commerce domains. This opportunity is ideal for: Entry-level candidates Career switchers...SuggestedRemote jobFull timeCurrently hiringFlexible hours
$43.8k - $62.5k
...Medical Claims Recovery Specialist (Subrogation) - Hybrid Arizona Great companies need... ...help identify, verify, and coordinate healthcare coverage for Medicaid members, while managing... ...revenue recovery, accuracy, and program compliance. What we're looking for High School...ClaimsFull timeWork at officeRemote workMonday to FridayFlexible hours- ...provide expert consulting services to its policyholders, including healthcare professionals and organizations. This role includes tasks such... ...while ensuring collaboration with various departments like Claims and Underwriting. The ideal candidate should possess a Juris Doctor...Claims
- ...Phoenix, Arizona. This role involves reviewing medical records to ensure compliance with coding standards and identifying any fraudulent activities. Candidates should have 3-5 years of experience in claims data, be knowledgeable in coding guidelines, and hold an active CPC,...ClaimsFull time
- ...Officer (CLO) About the Company Large integrated healthcare system Industry Hospital & Health Care Type... ...serve as a strategic leader in the oversight of legal, compliance, internal audit, risk, and claims and litigation. The successful candidate will be a...Claims
- ...to oversee back-end revenue cycle operations, including timely claim submissions, collections, reimbursements, and handling denials.... ...staff, set priorities, monitor performance, and ensure policy compliance across the department. The role emphasizes leadership, training...Claims
- ...Blue Signal Search Director of Staffing | Healthcare, Revenue Cycle Management, Accounting,... ...insurance reimbursements, and regulatory compliance. As a critical team leader, you will... ...coordinate resolution strategies for outstanding claims, and monitor metrics to optimize cash...ClaimsFull timeContract work
$45 - $55 per hour
Join to apply for the Healthcare Senior Business Analyst (Homecare Homebase focus) role at... ...cross-functional collaboration between IT, compliance, clinical, and operational teams. Lead... ...Health Support Business Analyst - Claims & Encounters Processing Phoenix, AZ $50,...ClaimsFull timeContract workRemote work- ...7 to one of Arizona's largest nonprofit healthcare systems, our culture is built on warmth... ...external reporting, research, and regulatory compliance. Essential Functions Inpatient: *... ...Medicare, NCCI, OCE, LCD, NCD, and other claim edit guidelines and protocol. Preferred...ClaimsApprenticeshipShift work
$145k - $165k
...Position Overview The Compliance Manager is a member of the FUJIFILM Holdings America Corporation... ...to laws and regulations, including healthcare compliance, anti-corruption, antitrust,... ...Policy, Anti-Kickback, False Claims Act, HIPAA, Anti-Corruption Policy and Antitrust...ClaimsRemote workFlexible hours$117.5k - $222.99k
...and Opportunity, MedInsight is one of the healthcare industry’s most trusted solutions for... ...enterprise risk management and regulatory compliance, data analytics and business... ...knowledge of payer operations, healthcare data, claims analytics, and health plan workflows, with...ClaimsFull timeWork experience placementRemote workFlexible hours$106.9k - $147k
...make enhancements to the methodology of claims/premium forecasting and eventually include... ...encourage personal wellness and smart healthcare decisions for you and your family while... ...of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act...ClaimsFull timeTemporary workApprenticeshipRemote workWork from homeHome office- ...professional seeking an exciting opportunity in healthcare? West Coast Ambulance is looking for a... ...processing and managing medical billing claims, ensuring timely reimbursements, and... ...Maintain billing records and compliance with regulations Assist in Order Intake...ClaimsFull time
- ...AM Community Bridges, Inc. (CBI) is an integrated behavioral healthcare agency offering a variety of different programs throughout Arizona... .... Working knowledge in key healthcare operations (e.g., claims/billing, coding, credentialing required. AHCCCS Health plan contracting...ClaimsContract work
- ...in Phoenix, Arizona. The role involves investigating suspicious claims and requires strong investigative abilities, exceptional... ...conducting interviews, providing status updates, and ensuring compliance with legal requirements while maintaining confidentiality. The...Claims
$50k - $70k
...Join a company that sees a better way for healthcare by being patient advocates, following... ...management, contract review, risk management, claims, litigation and other related matters.... ...of healthcare legal and regulatory compliance frameworks. Detail oriented with the ability...ClaimsContract workWork at officeFlexible hoursShift work- Axiomcareofaz is seeking a Billing and Collections Specialist in Phoenix, Arizona. This role involves processing insurance claims for medical services, monitoring client treatment coverage, and ensuring billing accuracy. Qualifications include a high school diploma and...Claims
$129.3k - $177.8k
...specific strategies, financial trends, medical claims drivers, and the organization's short-,... ...'s degree Actuarial experience in healthcare Experience using SAS, SQL, Snowflake,... ...Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation...ClaimsFull timeTemporary workFor contractorsApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$85k - $110k
...Reimbursement + Full BenefitsA rapidly growing multi-specialty healthcare organization is seeking a Physician Liaison to support referral... ...liaison or medical sales Personal injury case management Insurance claims adjusting Legal or plaintiff-side injury support Healthcare...ClaimsLocal areaRemote work- Resilient Health in Phoenix, AZ is seeking a Claims Specialist to support the day-to-day operations of the claims department by gathering information and processing medical and psychiatric healthcare claims. You will verify insurance eligibility, scrub claims for accuracy...Claims
$65k - $88.6k
...Humana is looking for an experienced Healthcare Investigator to join its industry leading... ...conduct a thorough investigation to maintain compliance with Humana and governmental... ...Knowledge of healthcare payment methodologies, claims, submissions, and payments • Strong organizational...ClaimsFull timeTemporary workFor contractorsApprenticeshipWork experience placementWork at officeLocal areaRemote workWork from homeHome officeMonday to Friday$54.55k - $92.06k
AlphaStaffHCM is seeking a Senior Auto Adjuster in Phoenix, AZ to manage complex auto insurance claims from start to finish. You'll handle negotiations, compliance, and collaboration with various stakeholders while ensuring top-notch service. This role requires a High School...Claims- CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring compliant coding and documentation across medical, behavioral health, transportation, and other services. The role requires auditing current records, communicating...Claims
- ...program by ensuring that taxpayer-funded healthcare payments are accurate, appropriate, and... ...sampling and independent medical review of claims to identify improper payments and... ...policy development when appropriate Ensures compliance of specialty physicians with PSC...ClaimsContract workFor contractorsWork at officeLocal areaFlexible hours
- Manager, Compliance and Regulatory Affairs Suvida Healthcare LLC Phoenix, Arizona, United States About this position Who We Are At Suvida Healthcare, we are... ...Participation OIG Compliance Program Guidance Stark Law False Claims Act Experience working in healthcare quality,...ClaimsContract workTemporary work
$95k
...Senior Account Executive Solventum, a new healthcare company with a rich history, is built on... ...maintain ongoing eligibility, including compliance with Solventum's driver policy,... ...postings and recruitment schemes that falsely claim to represent Solventum and seek to...ClaimsRemote workRelocation packageFlexible hours- ...seeking a physician leader to provide medical insight for Medicare claims reviews and national coverage determinations under the CERT... ...goals. In this role you will guide policy development, ensure compliance with ISO and quality management practices, and mentor CERT staff...ClaimsFor contractors
- ...oriented Dental Biller in Phoenix, AZ, to support their billing operations and ensure compliance in a mission-driven environment. Your role will involve entering patient data, submitting claims to various payers, and maintaining accurate records. Ideal candidates are...Claims
- ....NET Developer (Healthcare Insurance Industry Experience) 100% remote/contract MUST MUST MUST: Healthcare insurance (EDI 837 submissions... ...ideal candidate will combine domain expertise in insurance claims, member, and Healthcare provider data with advanced...ClaimsContract workRemote work
- ...leadership across the district. This role combines leadership for financial performance, risk management, contract compliance, contract negotiation, and claims management. The ideal candidate partners closely with operations to drive strong business outcomes,...ClaimsContract workFor subcontractor
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