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Claims Processing Expertise with Healthcare Domain Expert

Talent Groups

Hybrid in Minneapolis, Minnesota • Yesterday

Easy Apply

Contract

Depends on Experience

Senior SIU Analyst / Fraud Analyst / Healthcare Domain Only

DVI Technologies, Inc.

Remote • Yesterday

Easy Apply

Contract

45 - 50

Project Manager / Business Analyst - Healthcare Interoperability & Claims

TAP Innovations

Remote • 2d ago

Easy Apply

Contract

Depends on Experience

Facets - Technical Consultant with Healthcare Exp

Tektree Systems Inc.

Remote • 5d ago

Easy Apply

Contract

Depends on Experience

Manager, Full Stack Development Python / Go / Java, AWS (Healthcare Claims)

Bramkas Inc.

Remote • 6d ago

Easy Apply

Full-time

Depends on Experience

FACETS Claims Configuration Analyst

Kodeva LLC

Remote • Yesterday

Easy Apply

Contract, Third Party

65 - 70

VP/CTO -Healthcare Domain Lead (US Healthcare & Health Tech)

Balin Technologies LLC

Remote • 2d ago

Easy Apply

Full-time

Depends on Experience

Healthcare Enterprise Architect

Shakti Solutions

Remote • Today

Easy Apply

Contract

Depends on Experience

Project Manager with Healthcare domain

Infinite Computer Solutions (ICS)

Remote • 22d ago

Easy Apply

Full-time

Depends on Experience

Senior Automation QA Engineer – Healthcare Insurance Claims

iTek People, Inc.

Remote • Yesterday

Easy Apply

Contract, Third Party

$50 - $55

Healthcare Business Analyst

Impelsys, Inc.

Remote • Yesterday

Easy Apply

Third Party, Contract

$50 - $55

Senior QA Tester with Healthcare Domain

Infinite Computer Solutions (ICS)

Remote • 5d ago

Easy Apply

Full-time

Up to 75000

Healthcare Data Analyst

Codeforce 360

Remote • 6d ago

Easy Apply

Third Party, Contract

$50 - $55

Healthcare Data Scientist

FlairTech Solutions

Remote • Today

Easy Apply

Contract

Depends on Experience

Healthcare Claims Processor (Fully Insured)-Fully Remote

Elite Technical

Remote • 22d ago

Easy Apply

Contract

Health Cloud Solution Architect

NeuraFlash, Part of Accenture

Remote • Today

Full-time

USD 94,400.00 per year

Healthcare Data Analyst

Medica

Minnetonka, Minnesota • Today

Full-time

USD 62,700.00 - 107,500.00 per year

Lead Healthcare Data Analyst

Medica

Minnetonka, Minnesota • Today

Full-time

USD 102,100.00 - 175,100.00 per year

Senior Healthcare Data Analyst

Machinify

Remote • Today

Full-time

USD 140,000.00 - 170,000.00 per year

Java Developer with Healthcare Domain

Talent Groups

Remote • 8d ago

Easy Apply

Contract

Depends on Experience

Fraud Analyst / Healthcare Domain

DVI Technologies, Inc.

Remote • Yesterday

Easy Apply

Contract

$40 - $50

FHIR Subject Matter Expert

HPTech Inc.

Remote • 2d ago

Easy Apply

Contract

Depends on Experience

Healthcare Clinical Data Analyst

Katalyst Healthcares and Lifesciences

Remote or New York, New York • 8d ago

Full-time

Automation Test Lead with Healthcare domain

Infinite Computer Solutions (ICS)

Remote • Today

Easy Apply

Full-time

Up to $90,000

Epic HB/HB Claims Application Architect

Impact Advisors

Remote • Today

Full-time

USD 125,000.00 - 140,000.00 per year

Distinguished Architect, Software Development - Claims Automation and Processor Enablement

CVS Health

Remote or Texas • Today

Full-time

USD 175,100.00 - 334,750.00 per year

Senior QA Test Engineer with Healthcare Claims, Medicaid Medicare or PBM (Pharmacy Benefits)

Infinite Computer Solutions (ICS)

Remote • 22d ago

Easy Apply

Full-time

Depends on Experience

Job Details

Skills

Claims
Health Care
Medicaid
Business Rules
Business Analysis
Billing
Analytical Skill

Summary

Business Analysis & Solution Design

Elicit, analyze, and document complex business, operational, and system requirements
Translate business problems into functional requirements, workflows, process models, and user stories

Payment Integrity & Healthcare Domain Analysis end to end Claims

10+ years of Business Analysis / Business Systems Analysis experience
Strong U.S. Healthcare experience working with all Lines of businesses
Payment Integrity, Claims, FWA/Revenue Cycle Management experience

lifecycle of a claim, Claim Processing, Claim Auditing is a “MUST”.

Analyze the end-to-end Payment Integrity lifecycle, from pre-submission and pre-adjudication prevention through Prepay intervention, Postpay audit, overpayment recovery, and continuous improvement. PI spans eligibility, coding, billing, pricing, clinical evidence, provider contracts, payment policies, and regulatory requirements.
Support Pre-adjudication and front-end prevention by translating payment policies, coding and reimbursement guidelines, eligibility rules, and provider-facing error-prevention requirements into business rules, workflows, alerts, and actionable messaging that help promote clean-claim submission and avoid preventable denials.
Analyze Prepay capabilities including automated and manual claim edits, analytical claim selection, clinical and non-clinical reviews, medical-record and itemized-bill validation, correct-coding and reimbursement-policy checks, and claim routing or intervention outcomes such as allow, adjust, hold, pend, or deny.
Support Postpay and Recovery workflows that identify overpayments after adjudication, perform retrospective audit and investigation, validate findings, coordinate claim adjustments and recovery activities, and track cases through resolution while maintaining clear evidence and audit trails.
Perform root-cause analysis on Postpay findings, appeals, adjustments, recovery results, and repeat billing patterns to identify opportunities to shift recurring leakage upstream into Prepay edits, payment policies, provider education, or other preventive controls.
Apply working knowledge of cross-cutting PI capabilities including Waste and Error, Clinical PI, Facility Audit, Claims Cost Management, Payment Policy, Audit and Recovery, Fraud/Waste/Abuse, Coordination of Benefits, Subrogation, payment primacy, and avoided-spend initiatives.
Analyze COB, Subrogation, and payment-primacy scenarios to support accurate identification of primary coverage, third-party liability, payer responsibility, and related prepay avoidance or postpay recovery workflows.
Evaluate PI scenarios across commercial, Medicare, Medicaid, ASO, and other applicable lines of business, considering claim type, professional versus facility billing, reimbursement methodology, provider specialty and behavior, member eligibility and utilization context, state or regulatory requirements, and clinical versus non-clinical review needs.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 91099677
Position Id: 9138824
Posted 1 day ago

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Contact the job poster

Shiva Kumar Mudigonda

Recruiter @ Talent Groups

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Minneapolis, Minnesota

•

Today

Job Title : Senior Business Analyst / Business Systems Analyst Healthcare Payment Integrity & AI Location: Minneapolis, MN (Local to CST) Duration :Long Term contract Job Description: Bachelor's degree in Computer Science, Information Systems, Engineering, Manufacturing Engineering, or related discipline. 10+ years of experience in Business Analysis and Business Systems Analysis within the US Healthcare payer domain. Strong expertise in healthcare claims processing, adjudication, audi

Easy Apply

Contract, Third Party

Depends on Experience

Business Analyst/ Claims SME

Minneapolis, Minnesota

•

23d ago

Please don't submit irrelevant resumes Job Title Business Analyst/ Claims SME Location - Minneapolis, MN(5 days onsite) Salary: $100K base Salary (+ 10% of QPLC) Contract - $60/hr is MAX Note: Please ensure all submissions are within the agreed rate card for your respective agency. Key Responsibilities Business Analysis & Solution Design Elicit, analyze, and document complex business, operational, and system requirementsTranslate business problems into functional requirements, workflows, proc

Easy Apply

Full-time, Third Party

90,000 - 100,000

Bus Anlys Cnslt

Remote or Minneapolis, Minnesota

•

Today

job summary: Enterprise Healthcare client has an immediate opening for a highly motivated Bus Anlys Cnslt to join their dynamic and growing team. All qualified candidates are encouraged to apply! location: Telecommute job type: Contract salary: $23 - 33 per hour work hours: 8am to 5pm education: Bachelors responsibilities: What are the top 5-10 responsibilities for this position (please be detailed as to what the candidate is expected to do or complete on a daily basis)? Independently

Contract

USD23 - USD33

Health Plan Developer II - Enterprise Data Reporting

Minnetonka, Minnesota

•

Today

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that

Full-time

USD 70,200.00 - 120,400.00 per year