Claims Examiner Jobs in Jersey City, NJ

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Claims Examiner - Workers Compensation

TAJ Technologies, Inc.

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Remote

Contract

Its a remote position. Mandatory: Work comp claims handling experience is needed; loss time. Minimum 6+years of relevant WC experience required. PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation
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Posted 6 days ago | Updated 6 days ago

Claims Examiner - Workers Compensation(California)

MetaSense, Inc.

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Remote

Contract, Third Party

ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates an
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Posted 60+ days ago | Updated 22 days ago

Epic Resolute Professional Billing & Claims and Remittance Analyst

Tranzeal, Inc.

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Remote or Oakland, California, USA

Contract

Role- Epic Resolute Professional Billing & Claims and Remittance Analyst Location- Oakland, CA (Remote) Required certifications: Epic Resolute Role Description: We are seeking a skilled and experienced Application Analyst with expertise in Epic Resolute, and Claims and Remittance modules to join our dynamic team.This Epic Applications Analyst plays a critical role in the implementation and installation of Epic applications, module upgrades, new components, and modifications.This position is res
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Posted 7 hours ago

Sr. Project Manager with Guidewire Claims Center and Billing Center - Remote

XFORIA Inc

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Remote

Contract

Sr. Project or Program Manager with Guidewire Claims Center and Billing Center Location - Warren, NJ 100 % Remote. Experience with Guidewire Claims Center and Billing Center is required. We are looking for a Guidewire Project / Program Manager to work for a leader in the commercial insurance industry. This strategic leadership role is responsible for the seamless implementation and integration of the Guidewire platform into downstream systems within a Commercial Property & Casualty (P&C) Insuran
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Posted 1 day ago

Senior Lead Data Architect With FHIR & HL7 with claims exp

ProCorp Systems Inc.

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Remote

Third Party, Contract

Position: Data Architect With FHIR HL7 Location: Remote Duration: 12 months Requisition Job Description The Lead Data Architect is responsible for designing, building, and maintaining efficient and scalable Application architecture within an organization. They collaborate with various stakeholders to understand technical requirements, create robust solutions, and ensure the integrity, security, and performance of the application infrastructure. This includes having the strong ability to look aro
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Posted 2 hours ago

Epic Resolute PB Claims Analyst

Talent Groups

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Remote

Full-time

Position: Epic Resolute PB Claims Analyst Location: Remote Job Type: Direct Hire Job Description:The Professional Billing Claims Analyst position will be housed under a subsidiary organization. To implement, maintain, support, and maximize the use of clinical, financial, and administrative portions of the software applications utilized by client in conducting daily operations under the direction of the Manager of Professional Billing and Claims.Responsibilities: Maintaining current clinical, f
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Posted 4 days ago

Application Analyst Epic Resolute Professional Billing, Claims & Remittance

Tranzeal, Inc.

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Remote or San Francisco, California, USA

Contract

Application Analyst Epic Resolute Professional Billing, Claims & Remittance Job Summary: We re seeking an experienced Application Analyst with deep expertise in Epic Resolute Professional Billing, Claims, and Remittance modules. This role will be key in implementing, optimizing, and supporting Epic billing applications, enhancing revenue cycle workflows, and ensuring system integrity and performance. Key Responsibilities: Lead configuration and implementation of Epic Resolute and Claims/Remittan
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Posted 20 days ago | Updated 1 day ago

Remote QA Manager with Healthcare Payer and Claims exp

Infinite Computer Solutions (ICS)

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Remote

Full-time

Note : GCEAD, L2EAD, consultant can apply for this position who can work on W2. Job Summary: We are looking for an experienced QA Healthcare Manager to lead the quality assurance team in ensuring the reliability, security, and compliance of healthcare applications. The ideal candidate should have a strong background in healthcare software testing, regulatory compliance (HIPAA, CMS, FDA), test automation, and team leadership. Key Responsibilities: we need someone who understand healthacre paye
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Posted 21 days ago | Updated 11 days ago

Senior Data Scientist (100% Remote): Pharma & Claims Data Expert (Contract-to-Hire)

Rower

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Remote

Contract

Rower is hiring a Full-Time Data Scientist with deep experience in the pharmaceutical space and a proven track record working with healthcare claims data. This is a contract-to-hire role, ideal for someone who can hit the ground running and wants to grow into a long-term strategic position on high-impact projects. What We re Looking For: 8+ years of hands-on experience in data science, analytics, or statistical modeling Deep pharma domain knowledge including commercial analytics, market access,
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Posted 7 days ago

Enterprise Data Architect with Claims Adjudication Process

ProCorp Systems Inc.

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Remote

Contract, Third Party

Enterprise Data Architect with Strong Healthcare (Claims Adjudication Process) Location: Remote Duration: 12 months Requisition Job Description The Lead Data Architect is responsible for designing, building, and maintaining efficient and scalable Application architecture within an organization. They collaborate with various stakeholders to understand technical requirements, create robust solutions, and ensure the integrity, security, and performance of the application infrastructure. This includ
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Posted 7 days ago | Updated 7 days ago

Engineering Manager (Claims Platform)

Headway

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Remote or New York, New York, USA

Full-time

Headway's mission is a big one - to build a new mental health care system everyone can access. We've built technology that helps people find great therapists with the first software-enabled national network of providers accepting insurance. 1 in 4 people in the US have a treatable mental health condition, but the majority of providers don't accept insurance, making therapy too expensive for most people. Headway is building a new mental healthcare system that everyone can access by making it easy
Posted 60+ days ago | Updated 3 hours ago

Claims Systems Delivery Manager (Remote in US)

Gainwell Technologies LLC

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Remote or Milwaukee, Wisconsin, USA

Full-time

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary As a Claims Systems Delivery Manager (Remote in US) at Gainwell, you can contribute your skills as we harness the power of tec
Posted 10 days ago | Updated 11 hours ago

Enterprise Data Architect with Claims Adjudication Process - Remote

ProCorp Systems Inc.

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Remote

Contract, Third Party

Enterprise Data Architect with Claims Adjudication Process Location: Remote Duration: 12 months Healthcare Background Mandatory Requisition Job Description The Lead Data Architect is responsible for designing, building, and maintaining efficient and scalable Application architecture within an organization. They collaborate with various stakeholders to understand technical requirements, create robust solutions, and ensure the integrity, security, and performance of the application infrastructure.
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Posted 6 days ago

Business Systems Analyst (Provider, Hospitals, Revenue Cycle, Claims)

Saama Technologies, LLC

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Remote

Contract, Third Party

We are seeking a Sr. Business Systems Analyst (BSA) to support the Revenue Cycle and Claims domain for a hospital (Provider) ecosystem. The ideal candidate will play a pivotal role in analyzing data flows, understanding business processes, and delivering technology solutions that enhance operational efficiency across Registration, Scheduling, Billing, and Accounting. Key Responsibilities: Collaborate with stakeholders to gather, define, and document both current and future business and data need
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Posted 14 days ago

Health Claims Adjudicator (Licensed New York)

Sureminds Solutions

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Remote

Full-time

Inviting applications for the role of Management Trainee, Health Claims Adjudicator New York Licensed In this role, you will review, evaluate, and process medical claims submitted by healthcare providers or policyholders to ensure accuracy and compliance with insurance policies and for New York policies, adherence to State regulations. Responsibilities Claim & Appeals processing according to standard work & SOP Validation of information entered by indexer Verify coverage; evaluate eligibility
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Posted 3 hours ago

Medical Claims Auditor I (Remote, USA)

Gainwell Technologies LLC

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Remote or Austin, Texas, USA

Full-time

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary We are seeking a talented individual for a Medical Claims Auditor I who is responsible for processing all casualty or estate fu
Posted 52 days ago | Updated 11 hours ago

Medical Claims Auditor I (Remote, USA)

Gainwell Technologies LLC

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Remote or Houston, Texas, USA

Full-time

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary We are seeking a talented individual for a Medical Claims Auditor I who is responsible for processing all casualty or estate fu
Posted 52 days ago | Updated 11 hours ago

Medical Claims Auditor I (Remote, USA)

Gainwell Technologies LLC

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Remote or Dallas, Texas, USA

Full-time

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary We are seeking a talented individual for a Medical Claims Auditor I who is responsible for processing all casualty or estate fu
Posted 52 days ago | Updated 11 hours ago

Epic Resolute Professional Billing & Claims and Remittance

Tranzeal, Inc.

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Remote

Contract

Title- Senior Systems Analyst Location- Oakland, CA Job Information Job Description: Job Title: Application Analyst - Epic Resolute Professional Billing & Claims and Remittance Role Description: We are seeking a skilled and experienced Application Analyst with expertise in Epic Resolute, and Claims and Remittance modules o join our dynamic team. This Epic Applications Analyst plays a critical role in the implementation and installation of Epic applications, module upgrades, new components, and m
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Posted 19 days ago

Senior Epic Analyst - Hospital Billing Claims & Remittance/Professional Billing

Golden Resources. Inc.

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Ohio, USA

Full-time

Our client is looking for a Senior Epic Analyst to join their Team! The Senior Epic Analyst will be responsible for Service Now requests and hospital billing claims & remittance. This position designs configures, tests, and implements changes of assigned Epic system applications. In addition, this role will lead operational work groups and teams to gather and analyze requirements for new requests. The Senior Epic Analyst consults with Epic representatives, leadership, and subject matter experts
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Posted 32 days ago | Updated 1 day ago