Claims Examiner Jobs in Raleigh, NC

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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 9 days ago | Updated 9 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 25 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 3 days 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 4 days 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 3 days ago

PBM / RX Claims Test Analyst - Remote - Contract

Ztek Consulting

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Remote

Contract

Title: PBM / RX Claims Test Analyst Location: Remote Duration: Contract Top 3 skills required for this role? 1.PBM 2.Rxclaims 3.Manual Testing Job Description/ Responsibilities/ Years of experience- 4-5 years experience in Healthcare or a PBM desired. .NET C# experience as SDET Prioritize, manage multiple assignments, and direct the work of others to meet deadlines. Excellent communication (Verbal and Written) and collaboration skills. Superior organization, project management, and prioritiz
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Posted 2 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 22 days ago | Updated 4 days ago

Enterprise Data Architect with Strong Healthcare (Claims Adjudication Process, FHIR, HL7) - Remote

ProCorp Systems Inc.

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Remote

Third Party, Contract

Data Architect with Strong Healthcare (Claims Adjudication Process, 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 includ
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Posted 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 24 days ago | Updated 14 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 10 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 10 days ago | Updated 2 days ago

Legal Administrative Temp - Claims Support

Software Guidance & Assistance

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Raleigh, North Carolina, USA

Contract

Software Guidance & Assistance, Inc., (SGA), is searching for a Legal Administrative Temp - Claims Support for a contract assignment with one of our premier Human Resources services clients in NC. This role will be remote. *MUST BE LOCAL TO NC/SC Responsibilities : We are seeking a detail-oriented and organized Legal Administrative Temp to provide essential support to the firm's Employment Practices Liability ( "EPL") Claims team. This role will assist with administrative tasks including pul
Posted 15 days ago | Updated moments 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 9 days ago | Updated 2 days ago

Rx-Claims Test Analyst

RiseIT Solutions

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Remote

Contract, Third Party

Company: iTech US, Inc. Job Title: Rx-Claims Test Analyst Location: Remote Job Responsibilities: Experience in Healthcare or a PBM desired..NET C# experience as SDETPrioritize, manage multiple assignments, and direct the work of others to meet deadlines.Excellent communication (Verbal and Written) and collaboration skills.Superior organization, project management, and prioritization skills.Courteous and professional demeaner with the desire and ability to work as a team.Ability to interact and
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Posted 10 days ago | Updated 2 days ago

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

Saama Technologies, LLC

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Remote

Third Party, Contract

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 17 days ago | Updated 5 hours 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 days 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 55 days ago | Updated 10 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 55 days ago | Updated 10 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 55 days ago | Updated 10 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 22 days ago