Facets QA Lead Healthcare Claims & EDI Expert
Tata Consultancy Services
Tata Consultancy Services is seeking an experienced professional for a role focused on Healthcare Claims Processing. The position involves leading end-to-end testing for Claims, Enrollment, and Billing modules, and acting as a Subject Matter Expert for Claims Processing and EDI transactions. The ideal candidate will possess strong expertise in EDI formats and Facets, ensuring compliance with HIPAA regulations for all testing activities. Excellent stakeholder communication skills are essential. A comprehensive benefits package is included. #J-18808-Ljbffr Tata Consultancy Services
$80k - $100k
...Strong SME knowledge in Healthcare Claims Processing lifecycle Expertise in EDI formats - 837 (P/I/D), 8... ...Hands-on experience in Facets (Claims + Enrollment modules... ...Azure DevOps (ADO) for QA tracking Knowledge of... ...years of experience as Test Lead in Facets projects Deep...EDIClaims- ...identifying and correcting medical claim errors that may prevent payment... ...claims Responsible for 277 EDI transactions/rejections Working... ...charge, or elevate to the team lead and/or another medical billing... ...for becoming a subject matter expert on the payor policies. Responsible...EDIClaimsFull time
$71k - $90.25k
...Zelis, we modernize the healthcare financial experience... ...technology built by healthcare experts. Position Overview The... .... Assist in QA and/or UAT of new software... ...including hospital billing, claims editing, reimbursement... ..., Agilist, Teams, or Leading SAFe (preferred). Note:...ClaimsWork at officeLocal areaVisa sponsorshipFlexible hours$99k - $232k
...leadership to implement corrective training and process refinements; Leading process improvement and optimization; Serving as a key SME in... ...in life science meetings & events, pharmaceutical device or healthcare setting working with HCPs, HCOs or Patients;Identifying...SuggestedFull timeH1b- ...Claims Business Analyst Duration-6 – 12 months ++ Hybrid 3 Days a week: Charlotte, NC; Chicago, IL; Colorado Springs, CO; Conshohocken... ...– for each jurisdiction there's different compliance req edi calls; Verisk exp VERY HELPFUL, pbm, medical bill mngt, etd to adjudicate...EDIClaims3 days per week
$53.5k - $69k
Safety National is seeking an EDI Operations Specialist to ensure the accuracy and integrity of EDI data. The role requires skills in validating claims data, problem-solving, and collaboration with both internal and external stakeholders. Candidates should have a Bachelor...EDIClaims- New York Life's Group Benefit Solutions is seeking a Life Claims Specialist to develop skills in life insurance claim investigations, determine eligibility, provide ongoing claim administration, and communicate decisions and status updates. You will handle a high-volume...ClaimsRemote job
$97k - $189k
...used to their fullest potential. The Managing Director Strategic Claim Oversight leads the Severity & Excess Accounts team that both directly handles and oversees the highest exposure claims in Healthcare. Ensures the effective execution of claims handling practices and...ClaimsFull timeWork experience placementWork at office- ...through on test case(s)/script(s) with Test Managers, Requirement Leads, Project Managers, and Development Leads Perform and lead... ...Desired experience Electronic Data Interchange X.12 (EDI) and Medical Claims (837, 834, 277, etc.) A familiarity with cloud-based testing...EDIClaimsFull timeWork experience placementRemote work
- Zelis is hiring an experienced EDI Analyst II to support and optimize healthcare EDI integrations, focusing on ANSI X12 ERA transactions. You will troubleshoot complex issues, improve processes with automation, and ensure data accuracy, integrity, and HIPAA compliance....EDI
$105.4k - $207.8k
...This role sits within Converge for Healthcare, Deloitte's industry-focused asset... ...data and data standards (e.g., claims, remittances, EMR data, HL7, FHIR, X12 EDI), with the ability to reason through... ...develop client-facing materials, lead technical discovery conversations,...EDIClaimsLocal area- ...delivery Initiate order entry into Oracle via EDI, DRC, downloads from customer portals, or... ..., and complaints in a timely manner, leading inter-departmental teams to identify and... ...Marketing, and others as required Calculate claim or rebate amounts on specified accounts...EDIClaimsFull timeContract workWork at office
- ...HCPCS coding per guidelines. The role collaborates with Revenue Integrity and Patient Financial Services to resolve edits and improve claim processing. The candidate will respond to educational feedback, meet production standards, and stay current on documentation...Claims
- ...Sales Executive (Remote) to drive growth in healthcare revenue cycle services across the United... ...role focuses on selling clearinghouse EDI credentialing and end-to-end RCM solutions... ...healthcare providers and organizations. You will lead strategic outreach, manage the full sales...EDIRemote job
- ...Business Assistant Healthcare Related Experience Deer Creek Family Dental is looking for a... ...providers in the office File patient insurance claims and follow up on outstanding claims,... ...company with 20+ years of industry leading experience that provides a stable career...ClaimsDaily paidWork at officeLocal area
- The Travelers Indemnity Company is seeking a Technical Specialist in Overland Park, Kansas, to manage complex General Liability claims. The ideal candidate will have a Bachelor’s Degree and five years of claims experience. Responsibilities include managing a caseload of...Claims
- ...recommendations to reduce losses. The role requires strong consultative skills, proficiency with MS Office, and the ability to collaborate with underwriting, sales, and claims teams. Travel is required and a valid driver's license is needed. #J-18808-Ljbffr EMC Insurance CompaniesClaimsRemote job
$53.5k - $69k
Role Description We are seeking an EDI Operations Specialist who will take ownership of... ...role includes validating and analyzing claims data, partnering with internal stakeholders... ...to investigate and resolve anomalies, leading root‑cause investigations, implementing corrective...EDIClaimsWork at officeWork from home3 days per week$150k
...invites experienced Homeowner Field Adjusters to join our team in Missouri. You will investigate and adjust complex 1st party homeowner claims, determine coverage and damages, and produce comprehensive estimates up to $150K using Xactimate and XactAnalysis. Based in the St....ClaimsRemote job$65k - $82.65k
...our continued growth, Zelis is seeking an experienced EDI AnalystII to support and optimize healthcare EDI integrations with a primary focus on ANSI X125010... ...71 is a plus. Strong understanding of the healthcare claims lifecycle, payment processing, provider payment...EDIClaimsWork at officeLocal areaVisa sponsorshipFlexible hours- Steadily is seeking a Senior Property Claims Adjuster in Overland Park, KS for a full-time, in-office role. You will guide customers through complex property claims, owning large-loss files from assignment through resolution. You must have 3+ years in P&C claims, with...ClaimsFull timeWork at office
- ...a defined territory in the United States. You will educate physician offices on benefit investigations, prior authorizations, and claims processes while maintaining strong client relationships. The role requires travel up to 80% (4 days/week) within St. Louis, MO or New...ClaimsRemote job
- St. Louis Children's Hospital, part of BJC HealthCare, seeks an experienced Neurodiagnostic Tech II for the night shift to advance pediatric EEG care. You will perform diverse EEG studies, document findings in EMR, and work with a multidisciplinary team in a Level 4 Epilepsy...Night shift
- A healthcare facility in Overland Park, KS, is seeking a Radiologic Technologist responsible for performing diagnostic procedures, communicating with patients, and ensuring radiation safety. The ideal candidate must be registered with the American Registry of Radiologic...
- Parallon, part of HCA Healthcare, is seeking a Home Health Coder II to review and code home health and hospice notes, documenting coding recommendations and OASIS edits while collaborating with the denials team to resolve issues. You will promote Parallon coding as a service...
- The Healthcare Analytics role supports the Risk Adjustment Programs team by analyzing healthcare data to evaluate program performance, measure... ...North Dakota, and Texas. What you’ll do: Analyze healthcare claims, pharmacy, lab, and Risk Adjustment submissions data to...ClaimsLive inRemote work
$56.2k - $101k
...day-to-day work functions of the assigned claims area, provide technical and leadership... ...required. Previous experience in a supervisory/lead role with defined outcomes required.... ...lives. We provide access to high-quality healthcare, innovative programs and a wide range of...ClaimsFull timePart timeH1bWork at officeRemote workFlexible hours- ...transportation, energy, water, healthcare, and more. Learn more about... ..., and other property‑related claims. Responsibilities Conduct forensic... ..., coordinate with other experts, and produce client reports... ...facing skills and ability to lead cross‑functional project teams...ClaimsWork at officeLocal areaNight shift
$68.2k - $102.3k
...life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates... ...AK.The opportunity: The Senior Manager, Stop Loss and Health Claims leads our dynamic claims unit. In this critical role, you'll oversee...ClaimsWork at officeLocal areaFlexible hours- ...of appropriate corrective action plans. Leads investigations for adverse events and sentinel... ...facility-wide educational programs on healthcare risk management and related subjects for... ...loss or assets. Collaborates with the claims and insurance team regarding actual or potential...ClaimsFull timeLocal areaWork from homeFlexible hours
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