47 Results for

Claims Analyst Jobs in Philadelphia, PA

Jobs

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.

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.

New!

Philadelphia, PAToday

$85,000–$92,000

Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff. Education/Experience: Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.

New!

Philadelphia, PAToday

$85,000–$90,000

This role handles highly complex claims and plays a critical part in ensuring compliance with state regulations, timely investigations, accurate reserving, and effective claim resolution. The position requires strong analytical judgment, excellent communication skills, and consistent collaboration with clients, claimants, vendors, legal counsel, and internal teams.

Philadelphia, PA26 days ago

$38–$42 Per Hour
Contractor

Current coding certification (CCS, CPC, RHIA, RHIT) desirable but not required Minimum of five years related Claims, Operations or Business Requirement Development experience. 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.

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

We are a Fortune 200 company, 19,000 colleagues strong serving more than 10 million customers at six energy companies -- Atlantic City Electric (ACE), Baltimore Gas and Electric (BGE), Commonwealth Edison (ComEd), Delmarva Power & Light (DPL), PECO Energy Company (PECO), and Potomac Electric Power Company (Pepco). + Contacts: This position requires interfacing with various levels of personnel in Regional Operations, Distribution Operations, Transmission Operations, Customer Operations, Corporate Security, Communications, Regulatory, Legal and Claims, as well as operational interfaces with governmental agencies, industry associations, municipalities, and other utilities.

Philadelphia, PA28 days ago

$95,000–$104,686 Per Year

Review & track incident reports ensuring that follow-ups are complete; perform investigations under direction of in-house counsel or hospital peer review committees; complete regulatory reporting within the required timeframe if indicated; prepare reports of adverse events resulting in liability exposure; act as resource person for all Health System employees concerning risk management issues; investigate patient complaints & determine most appropriate method of management; participate on committees that address issues with risk management implications; complete clinical summaries for medical legal reviews, provide risk management educational sessions to individual departments or units. + BA/BS degree in Nursing required with Professional Nursing License in Commonwealth of PA required; 3 years’ clinical experience within last 5 years with prior experience in health care risk management, quality assurance, or case management positions preferred; may be required to travel throughout Medical Center, University Campus & Penn Medicine.

Camden, NJ30+ days ago

Works with institute/department staff, Billing, Coding, Revenue Cycle Analysts, Claims Review Nurses, Clinical Documentation Improvement, and/or other relevant staff to correct conflicting coding, ambiguous documentation, and incorrect charging and charging practices. Reporting directly to the Manager of Revenue Integrity and working closely with the CDM Analysts, the Revenue Integrity Analyst position will be responsible for all aspects of revenue integrity for assigned institutes, cost centers, and/or departments, including the following:

Philadelphia, PA21 days ago

$95,000–$104,686 Per Year

Review & track incident reports ensuring that follow-ups are complete; perform investigations under direction of in-house counsel or hospital peer review committees; complete regulatory reporting within the required timeframe if indicated; prepare reports of adverse events resulting in liability exposure; act as resource person for all Health System employees concerning risk management issues; investigate patient complaints & determine most appropriate method of management; participate on committees that address issues with risk management implications; complete clinical summaries for medical legal reviews, provide risk management educational sessions to individual departments or units. BA/BS degree in Nursing required with Professional Nursing License in Commonwealth of PA required; 3 years’ clinical experience within last 5 years with prior experience in health care risk management, quality assurance, or case management positions preferred; may be required to travel throughout Medical Center, University Campus & Penn Medicine.

Philadelphia, PA26 days ago

$2–$8 Per Hour

Working with Epic team, maintains the OMA/Epic provider enrollment interface which communicates provider enrollment status to Epic so that claims being held may be released for payment before timely filing limits prevent UPHS from collecting payment (this is one type of “OMA Edit” discussed more generally above). Primarily responsible for edit types designated “OMA Edits” (currently 10 types), but also serves as a department resource for resolution of edit types designated “Department Edits” (currently 8 types).

Philadelphia, PA30+ days ago

$66,000–$87,644.80 Per Year

Working under the direction of the Principal Investigator (PI), the individual will provide support for research involving the collection of prospective data from clinical trials and observational studies, observational data, electronic health records, large administrative claims, and echo imaging databases. + Long-Term Care Insurance: In partnership with Genworth Financial, Penn offers faculty and staff (and your eligible family members) long-term care insurance to help you cover some of the costs of long-term care services received at home, in the community or in a nursing facility.

Philadelphia, PA30+ days ago

$66,000–$87,644.80 Per Year

The role provides statistical, analytical, and data management support for multi-center clinical trials, implementation trials, observational studies, and mixed-methods research projects under the supervision of the Director of Clinical Research Operations, PPRC physician leadership, and senior statistical and epidemiologic faculty. + Long-Term Care Insurance: In partnership with Genworth Financial, Penn offers faculty and staff (and your eligible family members) long-term care insurance to help you cover some of the costs of long-term care services received at home, in the community or in a nursing facility.

Philadelphia, PA30+ days ago

We will not ask you to provide personal or financial information, including, but not limited to, your social security number, online account passwords, credit card numbers, passport information, and other related banking information until we begin onboarding activities, which will be coordinated by a member of the ParetoHealth People Ops Team with an @paretohealth.com email address. California Applicants: See Pareto's CCPA Notice of Collection for California Employees and Applicants for information about how Pareto Captive Services, LLC, Pareto Health, LLC, and Pareto Underwriting Partners, LLC, together with their respective subsidiaries (collectively, "Pareto") collects and uses personal information submitted by employment applicants.

Wilmington, DE11 days ago

$65,000–$70,000 Per Year

Maintain accurate project documentation and workflows in project management systems; collaborate with Senior Analysts and internal teams to ensure timely, high-quality deliverables; contribute feedback on process improvements and tool enhancements. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, seniority, geographic location, performance, travel requirements, revenue-based metrics, any contractual agreements, and business or organizational needs.

New!

Hamilton Township, NJ3 days ago

$65,000–$75,000 Per Year

Execute end-to-end payment processing for claims distributions, including high volumes of checks, ACH, and wire payments using a combination of in- house systems and multiple banking platforms. This role is responsible for executing and supervising day-to-day payment operations, ensuring accuracy and timeliness of payments, and serving as a key point of contact for clients.

Trenton, New Jersey11 days ago

Baker Tilly Advisory Group, LP and Baker Tilly US, LLP, trading as Baker Tilly, are independent members of Baker Tilly International, a worldwide network of independent accounting and business advisory firms in 141 territories, with 43,000 professionals and a combined worldwide revenue of $5.2 billion. Baker Tilly is a leading advisory, tax and assurance firm, providing clients with a genuine coast-to-coast and global advantage in major regions of the U.S. and in many of the world's leading financial centers - New York, London, San Francisco, Los Angeles, Chicago and Boston.

Wilmington, DE30+ days ago

Working knowledge of various databases utilized in accomplishing the research required to understand, track/monitor and improve submarine maintenance including Navy Enterprise Resource Planning (N-ERP), Product Data Reporting and Evaluation Program (PDREP), eCANNAB, the In-Service Submarine and Sustainment Reliability Portal (ISARP), the Naval Sea Logistics Center (NSLC) suite of tools, Maintenance and Ship Work Planning (M&SWP), and Submarine Maintenance Monitoring Information Systems (SMMIS) is preferred. The Team Submarine concept unifies once diverse submarine-related activities into a single submarine-centric organization with the goal of eliminating traditional stovepipe structures and processes that created impediments and inefficiencies in the submarine research, development, acquisition, and maintenance communities.

Philadelphia, PA21 days ago

Remote

The auditor will be expected to build/run complex queries to identify claims affected by the configuration change and analyze all claims to ensure that all outcomes are accurate based on the request. All auditors must attend ongoing training as needed and meet all production and quality goals to assist the team in meeting all required Service Level Agreements.

Pennington, NJ30+ days ago

Create the source to target mapping that documents the business name, definitions, business and data quality rules, RDM, Source and target and transformation logic. knowledge of, and experience, with database management system (DBMS) physical implementation, including tables, joins and views, specifically Oracle and Redshift.

Newtown Square, PA30+ days ago

Understanding and Implementing Payer Healthcare process for Medicare and Medicaid Claims (837) translation and Adjudication, 999 (Functional Acknowledgements) and 277CA (Claim Acknowledgements). Identify key stakeholders and construct stakeholder analysis ie how they are affected.

Princeton, NJ30+ days ago

Business Analyst/Product Specialist in the healthcare payer domain of Health Plan administration of self-funded clients who excels in client interactions, and can collaborate effectively stakeholders to analyze, define and manage requirements for client or product. You will work with business and solution delivery owners to define and document requirements for the assigned products and services, as well as write user stories, acceptance criteria, feature description decks, process flows, manage traceability and UAT.

Pennington, NJ30+ days ago

2. Create the source to target mapping that documents the business name, definitions, business and data quality rules, RDM, Source and target and transformation logic. 4. knowledge of, and experience, with database management system (DBMS) physical implementation, including tables, joins and views, specifically Oracle and Redshift.

Trenton, NJ30+ days ago

Provide required business and/or subject matter expertise for both project and production related activities on complex issues, including new strategic programs or initiatives impacting current and existing systems. testing plan, testing scenarios, testing schedule, testing outcomes, user task analysis, documentation, defect management, results analysis) to ensure minimal production defects are realized.

Princeton, NJ30+ days ago

$76,030–$92,100 Per Year

Work-life programs include paid national holidays and optional holidays, Global Shutdown Days between Christmas and New Year's holiday, up to 120 hours of paid vacation, up to two (2) paid days to volunteer, sick time off, and summer hours flexibility. + Demonstrated experience leveraging and/or implementing, AI-driven insights and digital tools to enhance customer engagement strategies, optimize HCP/patient experience, and drive data-informed commercial decision-making.

Princeton, NJ20 days ago

Work closely with business stakeholders (Underwriting, Claims, Actuarial, Finance, Operations) to understand reporting and analytics needs. Experience working with insurance platforms such as Guidewire, Duck Creek, Sapiens, or similar is highly preferred.

Dresher, Pennsylvania30+ days ago

$92,000–$127,000 Per Year

Selective's unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2025 and certification as a Great Place to Work® in 2025 for the sixth consecutive year. Total Rewards: Selective Insurance offers a total rewards package that includes a competitive base salary, incentive plan eligibility at all levels, and a wide array of benefits designed to help you and your family stay healthy, achieve your financial goals, and balance the demands of your work and personal life.

West Chester, PA14 days ago

PRO Pediatric Services, is seeking exceptional Board Certified Behavior Analysts (BCBA) to provide services at local school districts, charter schools, and intermediate units. Our school division, PRO Pediatric Services, supports students from Early Intervention age, up to grade 12 within school districts, charter schools, and intermediate units.

King of Prussia, PA10 days ago

Our school division, PRO Pediatric Services, supports students from Early Intervention age, up to grade 12 within school districts, charter schools, and intermediate units. Our PRO ABA division offers IBHS services to children and youth ages 2-21 with Autism and behavioral health diagnoses in homes, schools, and clinics.

Elkins Park, PA11 days ago

Media, PA30+ days ago

Remote

We test every employee who works here for these three core values because employees must have Empathy to care about our clients, Energy to provide the level of service we require, and Tenacity to go that "extra mile" to solve our clients' challenges. We specialize in high-risk industries that require dedicated, client-based broker services in the areas of Commercial Insurance, Workers' Compensation, Employee Benefits, Cyber Liability, Professional Liability, Farm & Agriculture, and Personal Insurance.

Hamilton Square, New Jersey11 days ago

$130,000–$150,000 Per Year

The Stop Loss Underwriting Training & Development Manager is a newly created role focused on strengthening Berkley Accident & Health’s underwriting talent pipeline and supporting consistent training, mentorship, operational excellence, and quality assurance across the underwriting enterprise. This individual will design and deliver structured training programs, lead mentorship efforts, support guideline maintenance, enhance quality controls, and ensure Underwriters have the tools and knowledge needed to advance into more complex underwriting roles.

Philadelphia, PA30+ days ago

$100,000–$150,000 Per Year

Long-Term Care Insurance: In partnership with Genworth Financial, Penn offers faculty and staff (and your eligible family members) long-term care insurance to help you cover some of the costs of long-term care services received at home, in the community or in a nursing facility. The architect will design and build the core infrastructure for ClaimSpy, our flagship claim feasibility assessment system, extending it from verifiable materials science claims to speculative AI technology forecasting — supporting DARPA's "create and avoid surprise" mission.

Newtown, PA26 days ago

$178,100–$207,800 Per Year

As the Director, Targeting & Alignment, you will be at the forefront of shaping commercial deployment and effective Targeting & Alignment implementation, leading a talented team, and pioneering next-generation analytical capabilities to deliver unparalleled value to our clients. This role requires a forward-thinking leader who can guide senior-level client discussions, leveraging deep industry expertise and the ability to derive insights from data for the purpose of maximizing brand value and optimizing brand performance and results.

Philadelphia, PA26 days ago

Full-time

Thanks to an experienced, in-house team of engineers, analysts, technicians and electricians, Sun Tribe O&M is able to provide best-in-class technical asset management and operations & maintenance ("O&M") services for our client-partners across a growing portfolio of over 150 operational sites throughout the region. SYSTEM OPERATION AND MAINTENANCEPerforms annual preventative maintenance inspections (PMIs) as assigned and completes relevant electronic inspection checklists / reports.

Philadelphia, PA30 days ago

Remote

Full-time

Oversee architecture changes for all data ingestion solutions and provide technical advice on complex data mappings and transformations, including production support guidance, researching, and responding to security vulnerability findings, and working with multiple vendors and teams to leverage existing architecture components. - Facilitate the creation of architectures that consider how the current system interacts with other internal and external systems and environments and ensure that the new system behaves and performs correctly, including: prioritizing backlog projects and coordinating with system and network administration personnel on maintenance, upgrades, changes, and performance needs.

Wilmington, DE26 days ago

Full-time

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com.

Trenton, NJ30+ days ago

As part of the Ford Customer Service Division (FCSD) strategy to reimagine the dealer support model, Service Engineering & Operations is establishing a dedicated team to manage and resolve technical cases from dealer technicians. In addition, this role will support dispute resolution activities involving warranty, legal compliance, and case testimony, offering a unique blend of technical, legal, and customer service experience.

Philadelphia, PA30+ days ago

The Department of Obstetrics & Gynecology has established a leadership role for a Vice-chair of Quality and Safety and Informatics to promote the development and implementation of clinical and educational programs designed to promote a culture of safety and continuous quality improvement, and related scholarly activity. • Work with the Women’s Health Clinical Effectiveness Team, Ob and Gyn QI committee chairs, and the OB Patient Safety Committee, faculty and residents to develop and implement quality and safety initiatives, and to develop clinical guidelines and pathways to improve the quality and delivery of care .

Philadelphia, PA30+ days ago

Remote

Translate across technical and non‑technical teams: Synthesize business objectives, contract terms, data requirements, and edge cases into clear, actionable guidance for rebate analysts, health plan analysts, data engineers, and software engineers, effectively framing language appropriately to each audience. As a Director, Rebate Operations, you will serve as the knowledge, operational, and communication hub for HealthVerity's Smart Contracts ecosystem, including owning client engagement and internal execution to ensure complex rebate agreements are delivered accurately and on time.

New!

Plainsboro, NJToday

For 25 years, its hard-working, innovative and collaborative team has invented next-generation antibody technology platforms and harnessed translational, quantitative and data sciences, resulting in a proprietary pipeline including bispecific T-cell engagers, antibody-drug conjugates, next-generation immune checkpoint modulators and effector function-enhanced antibodies. This role will require strong technical skills across data modeling, distributed data processing, ELT pipeline development, and dashboarding, with an emphasis on automation, observability, and engineering best practices supporting our EU and UK commercial data warehouse.

Philadelphia, Pennsylvania30+ days ago

$18–$18.30 Per Hour

As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference. Responsibilities: The Patient Government Accounting Analyst plays a crucial financial role in minimizing bad debt and maximizing revenue to meet Genesis HealthCare Business Excellence goals.

Princeton, NJ30+ days ago

$229,500–$278,100 Per Year

The Senior Director leads the US Commercial AI & Advanced Analytics to modernize marketing and commercial measurement, and to design, build, and operationalize AI‑enabled decision platforms that accelerate evidence‑based decision‑making across Marketing, Brand, Omnichannel, Field, and Commercial teams—raising the bar for how insights inform action at enterprise scale. The Senior Director, US Commercial AI & Advanced Analytics is accountable for enterprise‑grade commercial decision intelligence across BMS, owning the end‑to‑end analytical and AI backbone that drives investment decisions, customer engagement strategy, and performance optimization across brands and therapeutic areas.

Newtown Square, PA30+ days ago

Understanding and Implementing Payer Healthcare process for Medicare and Medicaid Claims (837) translation and Adjudication, 999 (Functional Acknowledgements) and 277CA (Claim Acknowledgements). Technology M/F, ODBA, SQL DBA, M/F DBA, App Support, Incident Management, etc.

Newtown Square, PA17 days ago

Remote

Demonstrate capability to manage staffing based on a combination of year-over-year run-the-business expense and projects including the use of contingent staff and sourcing models to meet variable staffing needs. Project Management: Manage IT initiatives from conception to completion, including cost and scheduled estimates, system implementations, upgrades, and migrations, ensuring projects are delivered on time, within budget, and in compliance with business case and quality expectations.

Camden, NJ30+ days ago

Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. Assist with manufacturer reports of REMS identified drug and data submission for limited drug distribution drugs.

Wayne, PA18 days ago

Resolves claims handling for orders in which directly responsible, while striving to reach a fair and equitable resolution for all parties involved, keeping Manager and appropriate accounting staff appraised of sensitive problems. Provides quotations to dealers and purchases product(s) at the best available prices in the marketplace, balancing the transactional and delivery timeframes required by the dealer.

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Claims Analyst Jobs in Philadelphia, PA

Jobs

Claims Analyst, Settlement AdministrationRG/2 Claims Administration LLC

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

Workers Compensation Claims Examiner IIITeemaGroup

Claims – Workers’ CompensationTEEMA Group

Business AnalystPyramid, Inc

Senior Business AnalystJudge Group

Sr Applications Bus AnalystExelon

Nurse Risk Management AnalystUniversity of Pennsylvania

Revenue Integrity Analyst - HybridCooper University Hospital

Risk Management Analyst for University of PennsylvaniaPenn Medicine

Payer Enrollment AnalystPenn Medicine

Statistical Analyst B - Epidemiology DivisionUniversity of Pennsylvania

Statistical Analyst B (OBGYN - Pregnancy & Perinatal Research Center)University of Pennsylvania

Lead Data AnalystParetoHealth

Associate AnalystTruveris

Payment Processing Analyst / ManagerPACE Claims Services

Temporary Application AnalystBaker Tilly Advisory Group, LP

Senior Logistics Analyst (Submarines) - Washington DCSerco

Configuration Auditor/AnalystAmeriHealth Caritas

Data Analyst- Pennington NJGeorgia Tek Systems

EDI AnalystDiverse Linx

Indium - Enterprise Business AnalystDiverse Linx

Data Analyst/Data Modeler-Pennington, NJ 08534Georgia Tek Systems

Senior Internal Business Systems AnalystHighmark Health

Senior Analyst Medicaid Rebate OperationBristol Myers Squibb

Senior Data AnalystTechDigital

Sr. Information Delivery Analyst (Hybrid)Selective Insurance Company of America

School-Based Board Certified Behavior Analyst ( BCBA ) - West Chester, PAPRO Companies

Board Certified Behavior Analyst - RBT SupervisorPRO Companies

School-Based Board Certified Behavior Analyst ( BCBA )PRO Companies

Account ManagerECBM, LP

Underwriting Training & Development ManagerBerkley

Application Architect - DARPA SciFy Project - Penn EngineeringUniversity of Pennsylvania

Director, Targeting & AlignmentSyneos - Commercial - Prod

Operations & Maintenance Technician II (Philadelphia Metro Area)Sun Tribe

Data ArchitectMaximus

Reporting SpecialistMaximus

Field Service EngineerFord Motor Company

Vice Chair for Quality and Safety and Informatics Department of Obstetrics and Gynecology, Associated Faculty Penn MedicineUniversity of Pennsylvania

Director, Rebate OperationsHealthVerity

Senior Data Product Engineer, CommercialGenmab

Government Revenue Recovery SpecialistFltr Philadelphia PA

Sr. Director, US Commercial AI & Advanced AnalyticsBristol Myers Squibb

EDI Developer @ Newtown Square, PADiverse Linx

Healthcare Manager, Data IntegrationAmeriHealth Caritas

Pharmacy Technician II - 340B Data CollectionCooper University Hospital

TraderLumbermens Merchandising Corporation

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