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Inpatient Medical Coding Auditor
Remote US, United States

Financial recovery DRG coding Inpatient Coding ICD MS-DRG Cost reduction Clinical Information DRG ICD-10-CM +49

USD 71K+

Escalation Response Specialist III
Remote-MO, United States

Centene Corporation

Provider experience Claims payment Escalation management Claims Adjudication Adjudication Contact center Customer Care Issue Resolution Problem Resolution +23

Senior Mid Full Time

USD 68K+

SIU Investigator, Senior Analyst
Remote

Investigative Techniques Provider Contracting Technology Platform Fraud detection Investigations HIPAA Compliance Process improvements Claims processing Contracting +20

Senior Mid Full Time

USD 69K+

Team Lead - Underwriting Operations - Remote
MORRISTOWN, NJ, United States

Policy Issuance Surplus lines Insurance Products Claims SharePoint Underwriting Microsoft Word Team Management Outlook +24

Senior Mid Full Time

USD 43K+

Sr Underwriter - Personal Lines (Concierge Team)
Ohio-Work from Home-2, United States

Underwriting policies Underwriting analysis Personal Lines Risk Evaluation Underwriting guidelines Customer Value State law Mitigation Property and casualty +37

Senior Mid Full Time

USD 55K+

Integrated Nurse Case Manager
Sentara Health Plans Roanoke - Remote, United States

Coordinate RN license Discharge planning Health Plan Clinical assessments Care Coordination RN Claims Care management +13

USD 111K+

Underwriter - Personal Lines (Concierge Team)
Ohio-Work from Home-2, United States

Underwriting analysis Personal Lines Risk Evaluation Underwriting guidelines Customer Value State law Mitigation Property and casualty Risk mitigation +27

USD 43K+

Senior Fraud and Waste Investigator
Remote US, United States

Dataset manipulation Medicaid Experience Analyzing Healthcare Industry Knowledge Investigative Process Development Vision Investigations Interviewing +47

Senior Full Time

USD 71K+

Integrated Nurse Case Manager
Sentara Health Plans Wise - Remote, United States

Coordinate RN license Discharge planning Health Plan Clinical assessments Care Coordination RN Claims Care management +13

USD 111K+

Senior Construction Risk Engineering Consultant
Virtual, KS, US

Zurich Insurance

Geotechnical risk analysis Natural catastrophe exposure analysis Building envelope reviews Energy sector risk analysis Hurricane emergency action plans QA/QC planning Water intrusion prevention Crane management Construction risk engineering +35

Senior Full Time

USD 98K+

Supervisor, Claims
Remote-FL, United States

Centene Corporation

Medical claims Cost control Researching Marketplace Financial Supervisory Procedures Claims processing Claims +22

USD 55K+

Fraud and Waste Investigator
Work at Home - Louisiana, United States

Healthcare payment methodologies MS Access Consumer Experiences Investigative Clinical Experience Process Development Vision Investigations MS Word +49

USD 65K+

Associate Counsel - Brooklyn, NY (Remote)
NY Melville (Office) - JPS, United States

Personal injury Civil Litigation Insurance defense Legal research Litigation Conflict Resolution Claims Multi-tasking Written communication +6

USD 118K+

Data and Reporting Lead (Value-Based Programs)
Remote US, United States

Visualizations Healthcare Claims HireVue HEDIS Data Models Pivot Tables Data Reporting Reconciliation Vision +50

Senior Mid Full Time

USD 97K+

Provider Data Management Analyst I
Remote-FL, United States

Centene Corporation

Provider data management Claims payment Healthcare operations Provider Relations Credentialing Claims processing Contracting Claims Managed Care +18

Entry Full Time

USD 38K+

Pharmacy Operations Specialist I
Remote-FL, United States

Centene Corporation

Pharmacy Claims Processing Quality process improvement Pharmacy operations Training materials Pharmacy Claims Pharmacy Technician UAT Medicare part d Power Automate +30

USD 44K+

Senior Manager, Configuration
Remote - USA

Clover Health Remote-first

Medicare Advantage CMS Configuration Management Claims processing Claims Operational Efficiency Medicare Health Insurance Vendor Management +20

Senior Full Time

USD 104K+

Client Success Analyst II
Remote, United States

Training and Onboarding Origami platform Origami No-code platform XML SaaS solutions Professional Services Claims Client service +18

Entry Mid Full Time

USD 66K+

Customer Service Advocate II - Outbound
Remote-AZ, United States

Centene Corporation

Outbound Calls CRM applications Contact center Customer Care Tracking Performance Tracking Quality Standards Audits Claims +18

Entry Mid Full Time

USD 55K+

Supervisor, Encounter Data Management
Remote US, United States

Optum Dos 835 Dos 837 Encounter data management Encounter data Edifecs CAS Microsoft Office Applications HireVue +55

USD 59K+

Grievance & Appeals Coordinator I
Remote-AZ, United States

Centene Corporation

Claims research Grievance resolution Managed care experience Grievances Researching HEDIS Organizing Appeals Medical management +16

Entry Mid Full Time

USD 64K+

Direct Markets Finance and Insurance Executive - Philadelphia
Virtual, PA, US

Zurich Insurance

Dealership training Profitability Software Proficiency Automotive Industry Insurance Knowledge Casualty insurance Reinsurance Microsoft Teams Insurance Products +17

Exec Mid Full Time

USD 64K+

Sr Manager, Provider Data Operations Implementation (Implementation experience a must)
Dayton WFH, United States

Provider data management Contract administration Provider Relations Healthcare Regulations Prior authorization Healthcare administration Project Planning Credentialing Enrollment +50

Senior Full Time

USD 92K+

Business Analyst III Claims Pricing
Remote-MO, United States

Centene Corporation

Benefit Creation Managed Care Systems Claims Payment Systems Fee Schedule Setup Structured Testing Managed Care Information Provider reimbursement methodologies Implementation processes Claims pricing +39

Senior Mid Full Time

USD 68K+

Operations Quality & Affordability (QAI) Director
Remote-MO, United States

Centene Corporation

Affordability Third party liability Business case management Claims accuracy Coordination of benefits Health care services Healthcare quality Payment Integrity Business Process +56

Exec Senior Full Time

USD 145K+

Sr. Risk Adjustment Administration Professional
Remote US, United States

EMR interoperability Claims Submission Population health management Medical Director Assist Provider education Interoperability Provider Relations Population health +64

Senior Full Time

USD 78K+

Integrated Case Manager/RN- Fairfax, Woodbridge, NOVA!
Sentara Health Plan - Northern Virginia Remote, United States

Behavioral health services Health care coordination Chronic Illness Management RN license Telephonic assessments Health Plan Experience Discharge planning Health Plan Clinical assessments +21

USD 111K+

Pharmacy Intern
Work at Home - Tennessee, United States

Prescription Technology systems Assist Microsoft Applications Typing Ethics Healthcare services Travel Verbal and written communication +29

Entry Internship Part Time

USD 40K+

Leave of Absence Administrator II - Remote
USA - Remote - North Carolina, United States

Leave of absence administration Vendor communication Employee support HR Collaboration Legal knowledge Healthcare administration ServiceNow Claims Confidentiality +21

USD 60K+

Senior Counsel - Specialty Finance / Financial Risk Solutions
Ohio - Columbus, One Nationwide Plaza, United States

Financial insurance regulation Insurance transactions Structured financing Cross-border transactions Legal expertise Securitization Legal Experience Legal Drafting State law +33

Senior Full Time

USD 139K+

Medical Coding Auditor
Remote US, United States

Encoder usage Clinical documentation review Medical Documentation ICD Medical claims Interventional Radiology Consumer Experiences Coding Guidelines CPT coding +38

USD 59K+

Integration Engineer
Remote, United States

Integration engineering Insurance experience Origami No-code platform P&C Insurance Functional Testing API Management User Stories SaaS solutions +29

USD 81K+

Marine Claims Senior Claims Specialist Role
Virtual, CA, US

Zurich Insurance

Actuarial trends Marine claims Insurance Regulations Litigation management Casualty insurance Litigation Insurance Industry Claims Prioritization +15

Senior Full Time

USD 74K+

Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management- Remote in VA!
Virginia Remote, United States

Behavioral health services Managed care contracting Coordinate Autism spectrum disorder Health Plan Experience Clinical protocols Compliance requirements Clinical Judgment Mental health services +27

Entry Mid Full Time

USD 101K+

Treasury Claims Analyst Senior - Remote
Home, United States

Prime Therapeutics

Unclaimed property management Regulatory Guidance General Ledger MS PowerPoint MS Word MS Excel Claims Regulatory requirements Pharmacy +21

Senior Full Time

USD 81K+

Corporate Medical Director - Medicare Grievances and Appeals (32-Hours)
Remote US, United States

Preservice appeals Rehab Health claims Grievances Hospitalist Family practice Medical interpretation Medical background Geriatrics +43

Exec Senior Full Time

USD 246K+

Manager, Behavioral Health Care Management/RN/LCSW/LPC/LCAS- Remote in VA!
Sentara Health Plans Community Care, United States

Quality Outcome Indicators Addiction recovery Claims analysis Human services Staff Development Healthcare Management NCQA LPC Health Plan +32

Senior Mid Full Time

USD 153K+

Temp Registered Nurse Medicare Case Manager - Remote (Virginia Only)
Sentara Health Plans Williamsburg - Remote, United States

Health care coordination Chronic Illness Management RN license Telephonic assessments Health Plan Clinical assessments Acute care Care Coordination RN +17

USD 94K+

Provider Engagement Account Manager
Remote-DE, United States

Centene Corporation

Consultative account management Demographic information changes Claims Submission Cost and utilization Quality measures Network performance Provider education Utilization Provider engagement +31

USD 55K+

Quality Practice Advisor
Remote-IL, United States

Centene Corporation

Performance Data Healthcare Standards Medical record documentation Cphq Risk Adjustment Coding Provider education HEDIS ICD-9 Guidelines +26

USD 52K+

Claims Review Representative
Work at Home - Florida, United States

DRG calculations Financial recovery APC calculations Claims review Medical claims CMS guidelines Microsoft Office Applications DRG HireVue +49

USD 43K+

Client Services Analyst I, Remote, USA
Any city, TX, US, 99999

Gainwell Technologies

Member eligibility Provider Referral management CMS guidelines Medical claims Data reconciliation Microsoft Visio Accuracy Prior authorization +36

Entry Mid Full Time

USD 50K+

Inpatient DRG Quality Auditor
Remote US, United States

Quality auditing Coding certification Medical Record Review DRG coding CAS Inpatient Coding ICD Analyzing HireVue +53

Senior Mid Full Time

USD 65K+

Technical Consultant - Large Clients
Remote, United States

Defect Resolution RMIS Policy Products Origami platform Report Design Incident Resolution Dashboard Design Origami Data Conversion +27

USD 92K+

Director of Presales Engineering
Remote, United States

Sales solution architecture Enterprise saas solutions Skill development RMIS Insurance Technology Origami Value proposition development Business value propositions Industry Best Practices +44

Exec Senior Full Time

USD 185K+

Grievance & Appeals Specialist II (Indiana or Ohio WFH))
Indiana WFH, United States

Clinical appeals Phone Etiquette Facets UAT UAT testing Resolution Healthcare Knowledge Certification Claims +25

USD 40K+

Sr. Workers Comp Claims Specialist
Virtual, CA, US

Zurich Insurance

Insurance Regulations Litigation management Casualty insurance Workers Compensation Claims management Litigation Insurance Industry Claims Prioritization +15

Senior Full Time

USD 81K+

SIU Investigator
Remote-NY, United States

Centene Corporation

Fraud and abuse Claims analysis Investigative Organizing Data Mining Report Writing Fraud detection Fraud Investigation Audits +14

USD 55K+

Pharmacy Resolution Specialist
Remote-FL, United States

Centene Corporation

Pharmacy benefits CMS regulations Outbound Calls Claims resolution Guidelines Inbound Calls Medical management Health Services Prior authorization +16

Entry Full Time

USD 30K+

Supervisor, Membership Data Integrity- User Acceptance Testing
Remote-AR, United States

Centene Corporation

HIPAA Transactions QTest Test Plan Creation Requirement analysis Amisys Business process documentation Data reconciliation UAT Microsoft Visio +44

USD 68K+

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