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Claims Resolution Analyst Remote-Vermont

Remote or Burlington, Vermont

•

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 Claims Resolution Analyst is responsible for reviewing and researching suspended claims, identifying and resolving issues a

Full-time

USD 35,000.00 - 50,000.00 per year

EPIC Resolute Certified - Claims Applications Analyst - REMOTE

Remote

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15d 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

QA Test Engineer with Medicaid and Claims - Remote

Remote

•

7d ago

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 Tes

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Contract, Third Party

Depends on Experience

Application Claims Architect – Claims IVR & Amazon Connect

Remote or Hybrid in Phoenix, Arizona

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5d ago

Application Claims Architect Claims IVR & Amazon ConnectRole SummaryThe Application Claims Architectis responsible for designing and governing the endtoend 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 bridges IVR modernization, lightweight AI/Virtual Agent capabilities, and Claims application integration, while honoring the constraint of no new

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Contract

Depends on Experience

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

Remote

•

30+d ago

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

Easy Apply

Contract

$60+

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

Remote

•

30+d 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

Easy Apply

Contract

$50+

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

Remote

•

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

Technical Business Analyst with Claims Module experience- Remote

Remote

•

13d ago

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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Contract, Third Party

$55

Medical Claims Processor, Xcelys, Remote

Remote

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8d ago

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our companys growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. For more than 25 years,NTT DATA Serviceshave focused on impacting the core of your business operations with industry-leading outsourcing ser

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Contract

Depends on Experience

Life Insurance Claims Specialist

Remote

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28d 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

•

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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6d ago

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 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 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 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

•

Today

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

Easy Apply

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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