Act as a technical leader for the Javelina platform, designing scalable solutions.
Serve as a subject matter expert on vendor platforms, delivering strategic guidance.
Translate business and technical requirements into system solutions.
Gravie aims to improve healthcare access through consumer-centric health benefit solutions. They foster a unique, non-hierarchical culture that values high-performance, fast-paced work, and making a positive impact on consumers' lives.
Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems.
Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams.
Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust and motivated by member well-being, not profits. They are committed to providing best-in-class service, sustainability, and innovation.
Analyze and improve UM business workflows, including clinical assessments, rules, and documents.
Validate Health Services programs against business requirements and acceptance criteria.
Partner with medical directors and cross‑functional teams to review, evolve, and update InterQual and custom clinical criteria.
Wellmark is a mutual insurance company owned by its policy holders across Iowa and South Dakota, and it has built its reputation on over 80 years of trust. They are motivated by the well-being of their members and committed to sustainability and innovation.
Centivo is an innovative health plan for self-funded employers that aims to bring affordable, high-quality healthcare to those struggling to pay their healthcare bills. They work with employers ranging in size from 51 employees to Fortune 500 companies.
Review and audit medical claims for accuracy and compliance.
Listen to customer service phone calls for accuracy and professionalism.
Prepare reports on audit findings and recommendations for process enhancements.
Point C is a National third-party administrator (TPA) delivering customized self-funded benefit programs. They focus on cost containment strategies with innovative solutions. The posting does not specify the number of employees or further details about the culture.
Leads creation of in-depth test plans and conducts User Acceptance Testing to ensure that systems meet business requirements.
Participates in the design of technology solutions based upon business needs.
Runs data queries and conducts data analysis to identify and solve business problems.
Mercury is committed to helping people reduce risk and overcome unexpected events. Guided by a diverse perspective, Mercury embraces the strengths and values of each team member to serve customers from all walks of life.
Provide advanced analytical, reporting, and problem‑resolution support across various departments.
Partner with operational, technical, clinical, and compliance teams to analyze trends and optimize processes.
Leverage technical acumen, including FACETS and reporting tools, to drive improvements and ensure compliance.
Capital Blue Cross is committed to providing exceptional service to their team and the community. They foster a flexible work environment where health and well-being are prioritized, valuing professional and personal growth through investment in training and continuing education.
Nava is on a mission to #fixhealthcare, fusing deep benefits expertise with cutting-edge technology to deliver a modern, transparent, and affordable healthcare experience. As a remote-first company, Nava is committed to building a dynamic and inclusive culture.
Supports compliance initiatives through data analysis and process improvement.
Develops and executes strategic business objectives supporting key business areas.
Develops training on compliance and privacy topics.
Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. Their aim is to make personalized genetic testing and diagnostics part of the standard of care. The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for their work and each other.
Perform quality review and evaluation of all claim submissions.
Determine the eligibility of assigned claim by applying appropriate contractual provisions.
Document rationale of claim decisions based on review of the contractual provisions.
Berkley Accident and Health designs innovative risk management solutions. They have an entrepreneurial culture with a strong emphasis on analytics, helping employers better manage their risk, and is backed by a Fortune 500 company.
Manages an inventory of claims to evaluate compensability/liability.
Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
Liberty Mutual strives to create a workplace where everyone feels valued, supported, and can thrive. They build an environment that welcomes diverse perspectives, embedding inclusion in their culture and everyday interactions, which includes offering comprehensive benefits and professional development opportunities.
Assist Revenue Cycle Consultant and Technical Consultant teams in the implementation of Experian's Claim Source revenue cycle management system.
Review internal process, recommend and develop changes to improve systems efficiency, automation, and effectiveness.
Document complex solutions to internal and external clients.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. They operate across a range of markets, from financial services to healthcare, automotive, agrifinance, insurance, and many more industry segments, with corporate headquarters in Dublin, Ireland, and a team of 23,300 people across 32 countries.
Build relationships and partnerships with key business stakeholders, staying current on their needs, challenges and strategies.
Gather, synthesize, and analyze complex data to recognize trends and extract insights across the business to support informed decisions.
Define operational support requirements and inputs by working with system solution owners and implementation teams to understand workflow strategic design and processes.
Ryan Specialty provides innovative solutions for insurance brokers, agents, and carriers. It is home to some of the brightest talent in the insurance industry and a multi-time winner of Newsweek’s Most Loved Workplaces and Insurance Business’s Top Insurance Employers.
Audits client data and generates high quality recoverable claims for the benefit of Cotiviti and our clients.
Conduct advanced, strategic analysis of paid claims, uncovering critical audit insights that drive process improvements and enhance organizational knowledge.
Make determinations based on prior knowledge and experience of client contract terms with the likelihood of recovery acceptance.
Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. They are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth.
Support the MPG Manager – MES in advancing Medicaid Enterprise Systems modernization initiatives.
Serve as a Business Analyst and MES Subject Matter Expert, supporting requirements gathering, analysis, and documentation.
Assist in the development of core MES deliverables and artifacts, including requirements and analysis documentation.
BerryDunn helps businesses, nonprofits, and government agencies throughout the US and its territories solve their greatest challenges. They are a client-centered, people-first professional services firm with a mission to empower the meaningful growth of their people, clients, and communities.
Support medical policy functions by providing medical coding and system configuration.
Perform coding analysis and utilization reporting to recommend updates to medical policies.
Participate in cross-functional meetings to align with enterprise strategic priorities.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. They are motivated by the well-being of their members and committed to sustainability and innovation.
Responsible for software development and support of provider-specific claim processing solutions.
Implement and configure customer environments, analysis, and maintenance within the Experian Health product portfolio.
Ensure provider-specific support development and processes meet corporate policies for security, consistency, and professional software development standards.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. They are a FTSE 100 Index company with a team of 23,300 people across 32 countries and corporate headquarters in Dublin, Ireland.
Lead the full onboarding lifecycle for new Employee Benefits customers.
Guide customers through contract review, billing setup, and use of online service tools.
Research and resolve customer inquiries of varying complexity by partnering with internal teams.
The Standard is dedicated to helping its customers achieve financial well-being and peace of mind. They are a leading provider of group and individual disability insurance, group life, dental and vision insurance, voluntary benefits, absence management services, and retirement plans and annuities.
Proactively review trends in outstanding A/R, denials, and various payment issues.
Pull and join multiple data sources together, including the use of SQL and API calls.
Communicate findings and recommendations with department and cross functional leadership.
BetterHelp aims to remove barriers to therapy and make mental healthcare accessible. They are the world's largest online therapy service with over 30,000 licensed therapists, focused on employee well-being and professional development.