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Remote

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Today

Senior Claims Examiner Remote 3 months contract (possible extensions) Responsibilities Review and assess supplemental health claims to determine eligibility based on policy terms and conditions.Gather necessary documentation from claimants, medical professionals, and other relevant sources to support the claim evaluation process (quantitative review).Analyze medical records, employment history, and other pertinent information to make informed decisions (qualitative review).Communicate with claim

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Full-time

$10 - $12

Claims Examiner - Workers Compensation - W2 Only

Remote

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4d ago

Position: Claims Examiner - Workers Compensation - W2 Only Location: Remote in California Pay Range: $48/hr to $53/hr on W2. Required Skills: SIP is mandatory5+ years of relevant California Workers Compensation experience 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 p

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Contract

$48 - $53

Senior Risk & Claims Manager - Onsite

York, Pennsylvania

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14d ago

Maxonic maintains a close and long-term relationship with our direct client. In support of their needs, we are looking for a Senior Risk & Claims Manager Job Description: Job Title: Senior Risk & Claims Manager Job Location: York, Pennsylvania Work Schedule: Onsite Pay Rate: $93/hr, Based on experience. Job Description: General Summary Provides risk management services to System entities. Evaluates the risk of financial or property losses and arranges for appropriate insurance coverage for su

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Contract

Depends on Experience

Sr. Analyst - PBM - claims adjudicator - Healthcare - Medicaid

Remote

•

Yesterday

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+

Claims Examiner

Park Ridge, Illinois

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Today

Job Description: Established nearly two centuries ago, FM is a leading mutual insurance company whose capital, scientific research capability and engineering expertise are solely dedicated to property risk management and the resilience of its policyholder-owners. These owners, who share the belief that the majority of property loss is preventable, represent many of the world?s largest organizations, including one of every four Fortune 500 companies. They work with FM to better understand the haz

Full-time

Claims Examiner

Park Ridge, Illinois

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Today

Full-time

Senior Systems Analyst (Application Analyst - Epic Resolute Professional Billing & Claims

Remote

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Today

Title- Senior Systems Analyst (Application Analyst - Epic Resolute Professional Billing & Claims and Remittance) Location - Oakland, CA Highly Preferred Candidates working Remotely must be from the PST Timezone. 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, m

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Contract

$80 - $90

CA:GEN with Billing and claims experience - REMOTE

Remote

•

Today

Role: CA:GEN Specialist Location: REMOTE MetaVance Expertise: Minimum 5+ years of hands-on development experience, specifically within Claims and Benefits modules.Tooling: Expert proficiency in CA:GEN, including Guardien, Report Composer, and CA:GEN APIs.Programming & Data: Strong command of C and Oracle SQL (SQL Developer) for complex data manipulation and analysis.Domain Knowledge: Solid understanding of Healthcare Claims Processing and benefits configuration.Professional Experience Experience

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Contract, Third Party

$0 - $0

CA:GEN, MetaVance - Technical developer (Healthcare Claims) - Remote

Remote

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7d ago

Role : Technical developer (CA:GEN & Healthcare Claims) Location: Remote Duration: Contract Job SummaryProject descriptionClient is seeking a Technical Developer to support enhancements and ongoing development of the MetaVance healthcare platform. The role focuses on claims processing, benefits configuration, and pricing functionality within the MetaVance application environment. The resource will contribute to system design, development, and technical analysis while ensuring alignment with heal

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Contract, Third Party

Depends on Experience

Medical Claims Auditor (Remote - Texas)

Remote or Dallas, Texas

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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 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

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Today

Full-time

USD 50,000.00 - 55,000.00 per year

Medical Claims Auditor (Remote - Texas)

Remote or Houston, Texas

•

Today

Full-time

USD 50,000.00 - 55,000.00 per year

Sr. Batch Developer (UNIX/C/SQL/Claims)

Milwaukee, Wisconsin

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Today

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have

Full-time

USD 70,000.00 - 90,000.00 per year

Senior Claims Platform SME – Advisory & Strategy

Remote

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27d ago

Key ResponsibilitiesProvide strategic advisory on claims platform transformation and modernization initiativesLead platform assessments, gap analysis, and optimization roadmapsDrive end-to-end claims lifecycle improvements (Enrollment, Benefits, Claims, Provider, Payment)Define enterprise architecture and integration strategy across claims ecosystemGuide platform migrations and upgrades (Facets/QNXT/HealthEdge/Diamond/Xcelys/ika)Partner with business leadership to align IT capabilities with paye

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Contract

60 - 70

Application Analyst Epic Resolute (Professional Billing, Claims & Remittance)

Hybrid in San Francisco, California

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Today

< data-section-id="yq6cja" data-start="71" data-end="139">Application Analyst Epic Resolute (PB, Claims & Remittance)Certification: Epic Resolute (Required) Role SummarySeeking an experienced Epic Resolute Application Analyst to support billing, claims, and remittance workflows. This role focuses on implementation, configuration, and optimization of Epic applications to improve revenue cycle performance. Key ResponsibilitiesImplement, configure, and support Epic Resolute (Professional Billing)Ma

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Contract

Depends on Experience

Claims Domain Test Lead

Remote

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22d ago

Job: Claims Domain Test Lead Location: Remote(USA) Claims Domain Test Lead: Play the role of Claims Domain lead for MMIS health care projects. Drive the test strategy and process, domain knowledge, performs analysis of business requirements, designs and develops test plans, ensures quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire life cycle. Responsible to meet customer expectations, troublesho

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Third Party, Contract

$70 - $75

Long Term Disability Claims Specialist

Remote

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Yesterday

We are looking for a LTD Disability Claims Specialist for a 12+ Months contract position. Please send your resume along with hourly rate expectation if interested. Position: LTD Disability Claims Specialist Location: Remote Duration: 12+ Months Part time position: 20 hours per week (Must be able to work during normal business hours within their residential time zone) Required: 3+ years of LTD/IDI Insurance Claims experiencePrior experience with independent judgement and decision making while re

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Contract

Up to 50

Epic Resolute Professional Billing Claims Remittance

Remote

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Today

Title- Senior Systems Analyst (Application Analyst - Epic Resolute Professional Billing & Claims and Remittance) Location- Oakland, CA/Hybrid/Remote 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 to join our dynamic team. This Epic Applications Analyst plays a critical role in the implementa

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Contract

Depends on Experience

Epic Build Analyst Professional Billing (PB) Claims & Remittance

Remote

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Yesterday

Job Title: Epic Build Analyst Professional Billing (PB) Claims & Remittance Duration: 6 Months Location: Remote Epic Build Analyst Professional Billing (PB) Claims & Remittance Principal Duties: Epic analyst certified in PB Claims and Remittance, must have extensive experience building payor/plans in Epic. Analyst will be covering support duties, assisting with upgrades, testing, tickets, and maintenance. Coordination with FTE's and operations, along with coordination from other applications as

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Contract

Depends on Experience

Healthcare QA Analyst for Payment Integrity and Claims Repricing.

Remote

•

Yesterday

Our direct client is looking for QA Analyst Payment Integrity and Claims Repricing. Location: Remote, CTH after 6 months Please send me your rate, contact details and current location. Key Responsibilities Claims Repricing Validation Validate claim repricing based on:Provider contractsFee schedules (CPT/HCPCS based)DRG/APC logicPercentage of billed chargesMedicare-based pricingVerify allowed amount, patient responsibility, and payer liability calculations.Test in-network vs out-of-network pric

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Contract

Depends on Experience

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