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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

Claims Analyst

Pierre, South Dakota

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19d ago

Job Title: Claims Analyst Work Location & Mode: Pierre, SD, Onsite Duration: 36 months, Job Description & Responsibilities The role involves augmenting staff for data entry, processing, and verification of medical services records. Technical Skills & Qualifications Qualified candidates must demonstrate the following: System Proficiency: Thorough familiarity with Datacap, Provider Enrollment Portal, and File Director. Claims Knowledge: Understanding of claims documents, specifically CMS-1500 an

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Full-time

$40 - $50

Claims Processing Specialist

Rancho Cordova, California

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8d ago

Claims Processing SpecialistLocation:Rancho Cordova, CA (onsite)Contract : 3+ Month (potential to extend)Work Schedule (Shift/Work Hours):6-2:30 or 7-3:30, M-F Job Description:The Claims Processing Specialist identifies and provides solutions for processing unique claims, refunds, overpayments, and underpayments. Other duties include processing special claims which may involve manual review of actual treatment compared to authorized treatment, and adjudicating VA CCN claims. ESSENTIAL DUTIESPerf

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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

Claims Operations Analyst

San Antonio, Texas

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Today

Job Title: Claims Operations Analyst Location: San Antonio, TX: 9800 Fredericksburg Rd,78288 (Onsite)Duration: 7-month contract (05/04/2026 12/31/2026)Schedule: Monday Friday, 40 hours/week Position Overview We are seeking detail-oriented Insurance Operations Analysts to support back-office functions within a claims-focused environment. This role will focus on ensuring accuracy, compliance, and quality across claims processing, underwriting support, and policy servicing activities. The ideal can

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Contract

USD0 - USD0

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

EPIC Resolute Certified - Claims Applications Analyst - REMOTE

Remote

•

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

Applications Claims Architect

Hybrid in Phoenix, Arizona

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6d ago

Application Claims Architect Claims IVR & Amazon ConnectRole SummaryTheApplication Claims Architectis responsible for designing and governing theendtoend Claims IVR architectureon Amazon Connect, ensuring seamless integration with existing Claims systems, compliant handling of customer data, and a scalable, modernized customer experience. This role bridgesIVR modernization,lightweight AI/Virtual Agent capabilities, andClaims application integration, while honoring the constraint ofno new Claims

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Contract

55 - 60

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

Application Claims Architect Claims IVR & Amazon Connect

Phoenix, Arizona

•

Today

Application Claims Architect Claims IVR & Amazon Connect Phoenix,AZ Onsite Role Summary The Application Claims Architect is responsible for designing and governing the endtoend Claims IVR architecture on Amazon Connect, ensuring seamless integration with existing Claims systems, compliant handling of customer data, and a scalable, modernized customer experience. This role bridges IVR modernization, lightweight AI/Virtual Agent capabilities, and Claims application integration, while honoring the

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Contract, Third Party

Depends on Experience

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

Remote

•

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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16d 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+

Claims Litigation Manager

Seattle, Washington

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Today

Join Grange Insurance Association, a well-established leader in the insurance sector for over 130 years! Headquartered in the city of Seattle, with a footprint stretching across six Western states, we've been protecting families, farms, and businesses with unwavering commitment. As you embark on a fulfilling career with Grange, discover why our average employee tenure surpasses a decade. Make your mark with an organization that values quality, service, and the lasting impact you can bring! Posi

Full-time

USD 79,276.00 - 147,228.00 per year

Delay Start Up & Builders Risk Insurance Claims Director of Quantum & Delay

New York, New York

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Yesterday

Join Rimkus and unlock your potential with endless opportunities for growth, learning, and making a difference! Rimkus ( is a worldwide leader in Engineering and Technical Consulting. Rimkus experts specialize in building envelope, engineering, forensic consulting, dispute resolution, construction management services, and solutions built for the environment. NOW IS THE TIME to join this growing and stable company! We offer our full-time employees a competitive salary, bonus opportunities, and a

Full-time

USD 185,000.00 - 225,000.00 per year

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

Philadelphia, Pennsylvania

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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

Senior Business Analyst - Healthcare Claims - MMIS

Indianapolis, Indiana

•

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 a Senior Business Analyst - Healthcare Claims - MMIS at Gainwell, you can contribute your skills as we harness the power of

Full-time

USD 69,400.00 - 99,200.00 per year

Claims Center BA

Lake Mary, Florida

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Today

RESPONSIBILITIES: Kforce has a client that is seeking a Claims Center Business Analyst in Lake Mary, FL. What You Can Expect as a Business Analyst II: * Work with major functional areas of the business to understand and document change requests submitted to the IT organization * Demonstrate knowledge of integrations with internal and external applications; Research dependencies and collaborate with solution architects and developers on system design plans * Review and analyze how changes to bus

Third Party, Contract

$50 - $70 hourly

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

Remote or Las Vegas, Nevada

•

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

Advisor Barch Developer (UNIX/C/Claims)

Frankfort, Kentucky

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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 100,000.00 - 115,000.00 per year

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

Remote

•

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

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