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Business Analyst - Medical Claims Processing | Contract-to-Hire | Philadelphia - Hybrid

Philadelphia, Pennsylvania

•

Yesterday

Job Title: Business Analyst AHA Philadelphia, PA 19103 - Hybrid 0(Tues, Wed, Thurs in office / Mon, Fri remote) Contract-to-Hire | Will convert to full-time in 3 months Pay rate: $45/HR - $52/HR W2 (negotiable) Job Description Seeking strong Business Analyst to support claims daily operations. This support will assist to move forward resolution of operational challenges, improve current processes and support project management initiatives. You will work closely with other team members and cros

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Contract

Depends on Experience

GuideWire Claims developer

Remote

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2d ago

Guidewire Claims developer Location : Remote Duration : Long Term Job Description: Software engineer who already understands Guidewire at a deeper levelspecifically, the underlying designs and how different integration patterns are applied. Experience across both real-time and asynchronous integrations, Configuration understand the trade-offs of each approach, and be able to apply broader software development and integration best practices in a Guidewire context. Tekshape

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Contract, Third Party

Depends on Experience

EPIC Resolute Certified - Claims Applications Analyst - REMOTE

Remote

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2d ago

Bachelor's degree in health care information technology, computer science, or related area, and / or equivalent combination of experience / training. 5 7 years related clinical applications experience or equivalent combination of education, training and experience. Please verify any certificates and/or licenses required for the position: Epic Resolute HB or PB Claims and Remittance Admin certification. Job Function: Involves the design, building, testing, and implementation of clinical applicati

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Contract

$80 - $100

Senior Majesco Configurator (Policy / Billing / Claims) (Remote)

Remote

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22d ago

Job Role: Senior Majesco Configurator (Policy / Billing / Claims) Location: Canada/USA- Remote Exp. Start date: 1st Week of May Duration: 6+ Months Year of Experience: 8-12 Years Role Summary Looking for a hands-on Majesco Configurator with deep expertise in configuring Policy, Billing, or Claims modules. Key Responsibilities Configure Majesco modules based on business requirements Work closely with business and BA teams for requirement analysis Perform product configuration, rule setup

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Contract, Third Party

$75 - $80

QA Test Engineer with Medicaid and Claims - Remote

Remote

•

Today

Should have strong MMIS health care domain experience and should have good knowledge of Medicaid and Medicare.Should have hands-on experience on claims processing and Adjudication processes.Must have good experience in Reference code/data sets required in Claims adjudication.Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.In depth understanding of Claims and Claims lifecycleClaim System:Testing knowledge and E2E Testing:

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Third Party, Contract

$50 - $55

Technical Business Analyst with Claims Module experience- Remote

Remote

•

Today

Minimum of 8+ years of experience in health care experience especially in MMIS domain.In depth understanding of Claims and Claims lifecycle:Claim submission Paper and EDI X12Adjudication Payment Cycle (Finance)ReportingEncounters and CapitationEDI X12 formats like837P/I/DX12 formats 835,834,270/271,276/277Familiarity with systems like CMdS, GHS, Facets and etcAbility to validate Test scenarios and test plans, test data.SQL: To validate data in backend tables (e.g., claim status, payment details

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Third Party, Contract

$55

Project Manager - PBM - PMP - Claims / Medicare - Medicaid

Remote

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17d ago

PBM is a must. Pharmacy or Health PlansClient PortalsProvider Network Management and/or Clinical Programs. Claims Adjudication is always a plus.

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Contract

$60+

Sr. Analyst - PBM - Claims / formulary adjudicator - Healthcare - Medicaid

Remote

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17d ago

PBM experience Agile Healthcare Government programs, compliance, or Medicare. NCPDP 4 year degree is required (must be achieved) claims adjudicator integration understanding with strong business and technical acumen

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Contract

$50+

Data Analyst Claims Operations

Remote or Dallas, Texas

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Today

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclus

Full-time

USD 72,800.00 - 130,000.00 per year

Claims Analyst

Philadelphia, Pennsylvania

•

Today

Innova Solutions has a client that is immediately hiring for a Claims Analyst. Position type: Full Time - Contract role Duration: 3 Months CTH Location: Philadelphia, PA 19103 As a Claims Analyst, you will:Support the processing team with analysis of claim issues and inquiries. Perform root cause analysis and course correct identified issues for full resolution. Research root cause of incorrectly processed claims.Provide solutions and coordinate with appropriate team members to repair the clai

Full-time

USD 45.00 - 52.00 per hour

Associate Business Process Services-Mailroom & Claims Team, Nevada / Remote

Remote or Las Vegas, Nevada

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Today

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 Associate Business Process Services-Mailroom & Claims Team, Nevada / Remote, you can contribute your skills as we harness th

Full-time

USD 35,000.00 - 58,500.00 per year

Senior Majesco Configurator (Policy / Billing / Claims) - SMC 26-04318

Remote

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Today

Job Title: Senior Majesco Configurator (Policy / Billing / Claims)Location: USA / Canada (Remote) Experience: 8 12 Years Role Summary We are seeking a skilled Senior Majesco Configurator with strong hands-on experience in configuring insurance platform modules such as Policy, Billing, or Claims. The ideal candidate will have deep domain knowledge and the ability to translate business requirements into effective system configurations. Key ResponsibilitiesConfigure Majesco modules based on busines

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Contract, Third Party

Depends on Experience

Life Insurance Claims Specialist

Remote

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15d ago

Our client, a major Life Insurance carrier is seeking a Life Insurance Claims Specialist for a long term (2 year minimum) contract position. This job can be worked remotely. The Life Insurance Claims Specialist will review contestable death claims, life insurance policy reinstatement requests, and evaluate Medical Information Bureau (MIB) inquiries for an existing book of business. Life Insurance Claims Specialist responsibilities include the following: Contestable claims review will require an

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Contract

$40 - $45

Lead Data Scientist - Clinical Informatics (Claims Specialization)

Remote or New York

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Today

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health , you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. Position Summary CVS Health's Analytics & Behavior Chan

Full-time

USD 130,295.00 - 260,590.00 per year

IT Project Manager (Claims Platform Implementation) - Remote (West Coast preference)

Remote

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Today

IT Project Manager (Claims Platform Implementation) Primary Location: Remote V-Soft Consulting is currently hiring IT Project Manager (Claims Platform Implementation) our premier client in Remote. Education and Experience 8+ years of IT Project or Program Management experience leading large-scale healthcare systems implementations. Deep expertise in implementing or upgrading core claims platforms (QNXT strongly preferred). This includes a strong understanding of claims adjudication systems/wo

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Contract

Depends on Experience

Medical Claims Auditor (Remote - Texas)

Remote or Dallas, Texas

•

Today

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 The Medical Claims Auditor is responsible for reviewing and analyzing medical claims to ensure accuracy, compliance, and adhere

Full-time

USD 50,000.00 - 55,000.00 per year

Medical Claims Auditor (Remote - Texas)

Remote or Austin, Texas

•

Today

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 The Medical Claims Auditor is responsible for reviewing and analyzing medical claims to ensure accuracy, compliance, and adhere

Full-time

USD 50,000.00 - 55,000.00 per year

Medical Claims Auditor (Remote - Texas)

Remote or Houston, Texas

•

Today

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 The Medical Claims Auditor is responsible for reviewing and analyzing medical claims to ensure accuracy, compliance, and adhere

Full-time

USD 50,000.00 - 55,000.00 per year

SAP S/4 Service Warranty claims with Automobile expereince

Remote

•

Yesterday

Job Description An SAP S/4 Service Warranty Consultant is responsible for designing, configuring, and optimizing Warranty Management processes within the SAP S/4HANA Service (formerly CS/SM) module. The role involves implementing endtoend warranty workflows, integrating service processes with logistics and finance, and ensuring accurate warranty claims processing for both internal and external stakeholders. Key Responsibilities Must Skills: S/4 services Warranty claims with Automobile

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Third Party, Contract

Depends on Experience

Provider Claims Training Specialist - San Diego, CA - Remote

Remote or Rancho Cucamonga, California

•

Today

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 The Provider Claims Training Specialist also known as Regional Representatives, support the provider community in a variety of

Full-time

USD 46,800.00 - 66,900.00 per year

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