230 Results for

Claims Analyst Jobs in Pennsylvania

Jobs

Allentown, PA22 days ago

Full-time

Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Claim and Denial Coding Analyst role is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC, MSO, and ASCs across the network.

West End, PA8 days ago

$80,000–$90,000 Per Year
Full-time
Employee

These matters include civil and criminal health care fraud, grant fraud, Government contracting fraud, investment fraud, and other forms of white-collar crime. Presenting the evidence of a fraud scheme to a jury, judge, and opposing counsel often requires visual exhibits and other means of summarizing the information obtained.

Pittsburgh, PA30+ days ago

Remote

This role bridges business needs with technical execution translating requirements into data mappings, validating data flows, and supporting scalable, high reliability data integrations across clinical and administrative systems. The ideal candidate will support complex data pipelines, SmileCDR operations, and FHIR-based data exchange while partnering closely with engineering, architecture, compliance, and external customers.

New!

Pottsville, PA2 days ago

Manages equipment maintenance and repair on trucks, trailers, liftgates, yard trucks and refrigeration units, while simultaneously assuring efficient and safe fleet operation. See Advantage AI Privacy Policy at https://www.advantage.ai/legal/privacy-policy and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.

PA30+ days ago

$18.50–$35.29 Per Hour

2+ years claim ACAS Medical claim processing experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently. Supports cost management programs to reduce medical claim expenses and identify and recover medical claim expense dollars from liable parties.

Wyomissing, Pennsylvania30+ days ago

Additionally, the system provides a wide range of healthcare services, such as Reading Hospital Rehabilitation at Wyomissing, home healthcare via Tower Health at Home, TowerDirect ambulance and emergency response, Tower Health Medical Group, Tower Health Providers (a clinically integrated network), and Tower Health Urgent Care facilities across its service area. Developing Knowledge/Skills - Obtaining an in-depth knowledge of the Epic platform for the supported application and a general knowledge of other applications supported along with a detailed understanding of the integration of modules within the Epic Enterprise.

Harrisburg, PA18 days ago

Remote

Compensation Information : The compensation offered to a candidate may be influenced by a variety of factors, including the candidate's relevant experience; education, including relevant degrees or certifications; work location; market data/ranges; internal equity; internal salary ranges; etc. Current Employees : If you are a current employee at Ryder, please click here (http://wd5.myworkday.com/ryder/d/task/1422$3.htmld) to log in to Workday to apply using the internal application process.

MIDDLE CITY WEST, PA30+ days ago

RG/2 is seeking a Claims Analyst who will be responsible for handling data entry of claimant information, claim review, report processing and reconciliation, updating and maintaining the firm’s database and document management systems, electronic and telephonic communication with claimants, claim payment distribution activities, and assisting in the preparation of periodic reports to courts and counsel. We believe balanced judgment, common sense, initiative and the capacity to confront a variety of situations are essential traits of a successful employee.

Pittsburgh, PA30+ days ago

In addition to delivering innovative solutions for Accenture's clients, you will work with a highly skilled, diverse network of people across Accenture businesses who are using the latest emerging technologies to address today's biggest business challenges. Job Description: Epic Certified Hospital Billing Claims Analyst will bring experience in managing applications, with a strong background in managing day-to-day operations, client stakeholder relationships, and collaboration with offshore teams.

PA30+ days ago

This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Wyomissing, PA30+ days ago

Philadelphia, PA30+ days ago

$60,000–$130,000 Per Year

About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators.

Pittsburgh, PA30+ days ago

In addition to delivering innovative solutions for Accenture's clients, you will work with a highly skilled, diverse network of people across Accenture businesses who are using the latest emerging technologies to address today's biggest business challenges. Job Description: Epic Certified Professional Billing Claims Analyst will bring experience in managing applications, with a strong background in managing day-to-day operations, client stakeholder relationships, and collaboration with offshore teams.

Philadelphia, PA29 days ago

The Senior Business Analyst reviews claims data and trends to determine if system enforcement is appropriate or requires adjustment, as well as identifying areas of improvement, system inconsistencies and training opportunities. · Provide quality assurance through development and review of claims data utilization reports to ensure assigned policies are enforced according to business requirements.

Philadelphia, PA29 days ago

You will work closely with other team members and cross functional teams such as configuration and Account Management to resolve discrepancies and improve claims processing experience for BlueCard members. • Responsible for evaluating current business processes and developing, implementing, testing and maintaining Technology for more cost effective or quality improvement processing.

PA30+ days ago

In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Corrects issues, conducts routine maintenance, updates systems with new functionality to meet the end user"s needs, and implements new technologies.

PA28 days ago

Epic Application Analysts 2-4 require current Epic training status (certification, accreditation, and/or proficiency) in primary application required, with a combination of current Epic training statuses in additional area(s) in application maintenance and development required in upper levels. Ideal candidates will possess strong experience as analyst with expert knowledge and experience in leading system analysis with special emphasis on system methodologies, projects management and business process reengineering related to information systems required.

Pittsburgh, PA13 days ago

Remote

Seven years of total related experience, including one year experience as a senior or lead, OR equivalent combination of education/experience. Coordinate Claims-owned regulatory updates and edits (CCI, LCD, MUE as well as periodic Epic upgrades (Nova Notes.

Allentown, PA30+ days ago

Harrisburg, PA30+ days ago

$60,000–$85,000

The position requires the ability to translate claims business needs into system requirements, assist with configuration, support implementations, and ensure smooth delivery across projects. Supporting MPL-related requirements such as incident/occurrence reporting, liability triggers, defense costs, reserves, and coverage nuances.

Pittsburgh, PA13 days ago

$128,000–$252,500 Per Year

Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.

New!

Home Teleworkers, PA5 days ago

Remote

$74,295–$82,550 Per Year

Alabama - Home Teleworkers, Alabama - Home Teleworkers, Arizona - Home Teleworkers, Arkansas - Home Teleworkers, California - Home Teleworkers, Colorado - Home Teleworkers, Connecticut - Home Teleworkers, Delaware - Home Teleworker, District of Columbia - Home Teleworkers, Florida - Home Teleworkers, Georgia - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Indiana - Home Teleworkers, Iowa - Home Teleworkers, Kansas - Home Teleworker, Kentucky - Home Teleworkers, Louisiana - Home Teleworkers, Maine Home Teleworkers, Maryland - Home Teleworkers, Massachusetts - Home Teleworkers, Michigan - Home Teleworkers, Minnesota - Home Teleworkers, Mississippi - Home Teleworker, Missouri - Home Teleworker {+ 21 more}. Partners cross-functionally with Claims Operations Support, TPA relationship managers, business leadership, Legal/Compliance teams, and operational partners to identify risks, evaluate performance trends, and develop solutions that support operational excellence and regulatory compliance.

Philadelphia, PA30+ days ago

$104,800–$178,100 Per Year

7+ years' experience in data analytics and/or business intelligence focusing on driving business decision-making, with a strong track record that demonstrates the ability to implement data-driven solutions and deliver tangible and measurable business impacts. This encompasses a comprehensive understanding of how claims data flow into, within, and outside claims systems, along with the intended use, dependencies, and impacts as well as a strong understanding of business processes and their associations with source system and/or vendor data.

PA28 days ago

New!

Malvern, PA4 days ago

Remote

Should be able to run queries and perform basic system analysis, RCA etc., Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos. Should have excellent communication (written and spoken ) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.

Philadelphia, PA30+ days ago

Five (5) or more years of healthcare claims audit or progressively more responsible experience in Customer Service, Enrollment, Claims, Provider Services, Medicare, Quality, or related administrative activities. Have familiarity and Acquire Working Knowledge Working with BCBSA guidelines for Member Touchpoint Measures (MTM), BCBSA Line Desk Level Audit (LDLA), and Multi-State Plan (MSP).

Berwyn30+ days ago

Remote

$126,100–$168,125 Per Year

Among the responsibilities of Senior Claims Counsel are the following:• Investigate the facts and issues of the claim, determine whether coverage exists, evaluate loss under the title policy, assess defenses for the insured and/or the company, determine need to retain outside counsel, develop and carry out a plan to address the claim and manage the claim and/or litigation through to final resolution • Negotiate settlements and resolutions with claimant / opposing counsel / third parties• Appear as company representative in court proceedings, mediations, settlement conferences and trials• Manage claim budget, review and approve outside counsel invoices and other expenses and determine settlement and expense reserves• Direct outside counsel on litigation strategy through the course of claim administration and litigation• Identify and pursue sources for recoveryJob Qualifications• Must possess excellent written and verbal communication, negotiation and organizational skills• Law Degree required• Licensed and in good standing to practice law in any state of the United StatesAbility to develop, evaluate and implement resolution strategies to fully conclude a claim. The Senior Claims Counsel position with First American Title Insurance Company provides an excellent opportunity for counsel to engage in complex legal analysis, craft creative solutions to difficult problems, manage their own caseload, oversee outside litigation counsel, and engage in high-level problem solving, negotiation and legal analysis in a stimulating and collegial environment with an opportunity for long-term growth and advancement.

EXTON, PA30+ days ago

$117,000–$184,400 Per Year

Managing assigned complex Cyber and Technology claims across multiple jurisdictions, setting the case strategy for these claims in partnership with the Cyber Practice Leader and Claims Management, and taking all available steps to achieve the optimal outcome. By combining a comprehensive and efficient capital platform, data-driven insights, leading technology, and the best talent in an agile and inclusive workspace, empowered to deliver top client service across all our lines of business - property, casualty, professional, financial lines and specialty.

Philadelphia, PA12 days ago

Remote

The Auditor, Payment Integrity role conducts pharmacy claim audits for Independence Blue Cross to ensure accurate provider payments, detect fraud, waste, or abuse, and improve audit processes. It requires a Certified Pharmacy Technician with at least four years of experience, including pharmacy and audit work, strong analytical skills, and proficiency in Microsoft Office and pharmacy claims systems.

Wyomissing, PA30+ days ago

$85,600–$141,200 Per Year

Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts.

Philadelphia, PA21 days ago

$35–$38 Per Hour

Assist with designing test plans and evaluate/ test new or modified processes and procedures to verify that the new programs or program changes are functioning as intended and conform to established policies. Support assigned projects, maintain appropriate documentation at a task level, monitor deadlines and budget allocations and service as a technical liaison when appropriate.

CAMP HILL, PA30+ days ago

As member of our legal team you will ensure compliance with Defense Counsel Guidelines as well as develop and maintain solid internal and external client relationships, perform legislative and/or regulatory research and analysis and advise internal clients of developments in workers' compensation law and procedure. Utilize your litigation experience and legal knowledge to represent insured and self-insured employers in the litigation of workers' compensation claims, to prepare legal correspondence, memorandums, briefs and pleadings and participate in the negotiation and settlements of litigated claims.

Philadelphia, PA29 days ago

$50–$52 Per Hour

Philadelphia, PA30+ days ago

Philadelphia, PA26 days ago

$40–$45 Per Year

By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. • Communication Skills: Strong written and verbal communication skills for interacting with various stakeholders and resolving issues quickly.

Philadelphia, PA30+ days ago

$38–$42 Per Hour

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Provide quality assurance through development and review of claims data utilization reports to ensure assigned policies are enforced according to business requirements.

Rockwood, PA13 days ago

$111,384–$132,498 Per Year

Qualifications / Experience Required: A working knowledge of the claims business environment in order to effectively discuss and prioritize reporting needs through: A minimum of five years' experience focused on data and compliance in a claims environment or other equivalent experience working with data gathering and analysis. Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers' ability to be profitable).

Harrisburg, PA8 days ago

The Network Reimbursement Analyst works with the team manager and other analysts from within the same unit to develop and administer pricing for contracts between Capital BlueCross and various providers of health care services, including professional providers, hospitals, non-hospital providers and ancillary providers. Acts as an advisor for the Network Provider Contracting and Network Analytics and Contract Support teams to answer questions relating to payment and system configuration around fee schedules and facility reimbursement to determine the urgency and importance of system change requests/problems.

Harrisburg, PA7 days ago

Working at Home, PA18 days ago

The analyst will be heavily involved in provider-facing activities such as assisting with the Helion Provider Help Desk to answer questions related to Utilization Management and claims processing, collaborating with the development team to draft agreements, and assisting with health plan contract negotiations. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Philadelphia, PA30+ days ago

$35–$40 Per Year

By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. The Senior Business Analyst reviews claims data and trends to determine if system enforcement is appropriate or requires adjustment, as well as identifying areas of improvement, system in consistencies and training opportunities.

Philadelphia, PA30+ days ago

The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients.

Harrisburg, PA30+ days ago

MHC is now a multi-state network of full-service diesel truck dealerships, leasing and rental operations, transport refrigeration locations, and a finance company which offers a complete array of finance and insurance services. Follows-up with Service Managers to ensure all warranty parts are properly tagged and stored in the warranty holding area.

New!

Any city, PA2 days ago

Remote

$95,100–$135,000 Per Year

Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. This role provides hands‑on technical analysis, SQL development, data validation, integration support, and system troubleshooting across one or more functional domains, including Member, Provider, Claims (Medical, Dental, and/or Pharmacy), Utilization Management, Prior Authorization, Finance, and Plan/Care Management.

Harrisburg, PA12 days ago

$80,000–$90,000 Per Year

Home Teleworkers, PA9 days ago

Remote

$110,700–$123,000 Per Year

Alabama - Home Teleworkers, Alabama - Home Teleworkers, Arkansas - Home Teleworkers, Colorado - Home Teleworkers, Connecticut - Home Teleworkers, Delaware - Home Teleworker, District of Columbia - Home Teleworkers, Florida - Home Teleworkers, Georgia - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Indiana - Home Teleworkers, Iowa - Home Teleworkers, Kansas - Home Teleworker, Kentucky - Home Teleworkers, Louisiana - Home Teleworkers, Maine Home Teleworkers, Maryland - Home Teleworkers, Massachusetts - Home Teleworkers, Michigan - Home Teleworkers, Minnesota - Home Teleworkers, Mississippi - Home Teleworker, Missouri - Home Teleworker, Montana - Home Teleworkers, Nebraska - Home Teleworkers {+ 20 more}. Pursuit or completion of industry-relevant continuing education, including graduate degrees, MBS, risk and insurance designations from The Institutes (AINS, AIC, ARM, CPCU, etc.), or actuarial exams and designations (ACAS, FCAS, CERA).

New!

Pittsburgh, PA5 days ago

Remote

Query medical and/or pharmacy claims and conduct a risk assessment by performing data analysis and applying applicable coding guidelines, Health Plan policies and any applicable National Coverage Determination (NCD or Local Coverage Determination (LCD.Evaluate referrals from Pharmacy Benefit Manager (PBM by analyzing medical and pharmacy claims and associated clinical documentation in HealthPlaNET, Mars, Epic and/or Cerner. The Clinical Auditor/Analyst is an integral part of the Special Investigations Unit (SIU and is responsible for conducting clinical audits and reviews regarding the analysis of care and services related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization.

New!

Philadelphia, PA5 days ago

$65,000–$110,000 Per Year

We bring a combination of broad-based expertise with specialized knowledge of specific risks, allowing us to provide independent, objective advice in the three primary areas of risk: healthcare, life and annuity, and property and casualty. If interested in the ICG, feel free to check out our ICG job simulation here, Oliver Wyman Integrated Consulting Group - Forage, for an immersive experience designed to introduce you to the high-impact work of the strategy, risk, and transformation work we do.*.

Camp Hill, Pennsylvania30 days ago

Additional Data: Select Medical and its parent company, Select Medical Holdings Corporation (NYSE: SEM), are based in Mechanicsburg, Pennsylvania, and are honored to be recognized as one of America’s Best-In-State (Pennsylvania) Employers 2020 by Forbes. They will act as a liaison between other departments within the organization to facilitate communication of reimbursement policies, procedures, and resolutions to issues causing delays to cash and accounts receivable management.

Pittsburgh, PA22 days ago

Remote

The Quality Improvement Analyst must use their knowledge and understanding of quality, clinical and other information generated by numerous sources to identify opportunities to improve clinical and quality performance. The successful employee is comfortable with ambiguity in priorities and is able to maintain professionalism and a team-player attitude in the face of analytical challenges of moderate-to-high complexity.

Stand out to leading employers.

Upload your resume and let employers find you for new Claims Analyst job openings. Plus, receive relevant job matches delivered straight to your inbox.

Create A Free Account

Claims Analyst Jobs in Pennsylvania

Claims and Denial Coding Analyst St. Luke's Health Network, Inc.

Senior Financial Analyst/Investigator Cameo Consulting Group

Business Analyst-CW TPI Global Solutions

Fleet Maintenance Manager Dollar General

Medical Claims Analyst - OPS - ACAS CVS Health Corp

Epic Hospital Billing Claims Analyst Tower Health

Claims Analyst - REMOTE Ryder System Inc

Claims Analyst, Settlement Administration RG/2 Claims Administration LLC

Epic Certified Hospital Billing Claims Analyst 5944595 Accenture Plc

Senior Stop Loss Claims Analyst Highmark Inc

Epic Hospital Billing Claims Analyst Tower Health Medical Group

Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations Stout Risius Ross LLC

Epic Certified Professional Billing Claims Analyst 5944596 Accenture Plc

Business Analyst- Healthcare Claims Dale Workforce Solutions

Business Analyst - Claims Dale Workforce Solutions

Epic Systems Analyst- Resolute Hospital Billing & Claims Highmark Inc

EPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full Time SolutionHealth

Systems Analyst - Team Lead (Epic HB Claims and Remittance University of Pittsburgh Medical Center

Claims and Denial Coding Analyst St. Luke's University Health Network

Business Analyst (Claims & MPL) Adept Consulting Services, Inc.

Insurance Claims Business Analyst Deloitte Touche Tohmatsu Ltd

Commercial Claims Quality & Performance Analyst III - Remote CSAA Insurance Group

Claims Data Solutions Sr. Analyst Chubb Ltd

EPIC Applications Analyst (1-4): Professional Billing Admin and Professional Billing Claims - IT Services - Full Time SolutionHealth

Senior Business Analyst – Claims module Carman Solutions Group

Senior Claims Audit Analyst Blue Cross and Blue Shield Association

Senior Claims Counsel - Title Insurance (remote) First American Financial Corp

Senior Claims Specialist, Cyber AXA SA

Pharmacy Claims Auditor (Remote) Blue Cross and Blue Shield Association

Technical Specialist, Construction Claim The Travelers Companies Inc

Quality Business Analyst Alpha Business Solutions

Sr. Claim Counsel PMA Insurance Group

Business Analyst AHA Alpha Business Solutions

Business Analyst Alpha Business Solutions

Business Analyst AHA Judge Group

Business Analyst Pyramid Consulting, Inc

Technical Data Analyst Argo Group International Holdings Inc

Network Reimbursement Analyst II Capital Blue Cross

Network Reimbursement Analyst II Blue Cross and Blue Shield Association

Provider Contract Analyst Highmark Inc

Senior Business Analyst Judge Group

Actuarial Systems Business Analyst Chubb Ltd

Warranty Analyst Murphy-Hoffman Company

Advisor Technical Analyst - MMIS / Medicaid Pharmacy Gainwell Technologies LLC

Senior Financial Analyst/Investigator Cameo Consulting Group, LLC

Commercial Insurance Analyst - Remote CSAA Insurance Group

Clinical Auditor/Analyst (Remote- Fraud, Waste and Abuse University of Pittsburgh Medical Center

Oliver Wyman Actuarial - Full-Time Consultant and Analyst Roles - 2027 Marsh & McLennan Companies Inc

Financial Recovery Analyst Select Medical

Quality Improvement Analyst, Senior- Remote (Health Plan Experience University of Pittsburgh Medical Center

Similar Job Searches