UNKNOWN

FEED

Bachelor's degree in business or related field and 7+ years of handling complex claims as determined by Society Insurance - OR - 10+ years of claims handling experience involving the exercise of discretionary decision-making and increasing levels of claims complexity, including specialized coverages and loss adjustments as determined by Society Insurance. At the direction of Claims Director, Claims Managers and/or Compliance Manager, assists with state interest credit, state penalties, Physician Panels, annual state reporting needs (e.g., Colorado surveys, change of physician, Longshore reporting) which are not already overseen by another department such as Insurance Product Management.

Society Insurance

Senior Claims Representative Analyst

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The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants. Researches all complex claims, disputes and appeals thoroughly to make accurate payment decisions in a timely manner with input from the Claims Analysts for quality assurance.

South Florida Community Care Network

Claims Examiner

Hiring #BillingAndCoding #HospitalBilling #RevenueCycle #UB04 #MedicalBillingJobs #DallasJobs #ClaimsAnalyst #HealthcareFinance #NowHiring. This is a high-paying, research-intensive role with incredible perks —perfect for an experienced professional who loves digging into complex claims and maximizing reimbursements.

We stand for PERSEVERANCE, as we refuse to quit when the journey gets tough. Your gold is our mission, and we search day and night to find it.

Phaxis

Billing, Coding, and Claims Resolution Specialist

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Key Responsibilities: Data Integration & Mapping: Design, develop, and maintain data mappings and transformations for incoming and outgoing healthcare data files: 837/835 - claims & remittance, 270/271 - eligibility and responses, 278 - Prior Auth, 276/277 - claim status, 999/TA1 - file level acknowledgement as well as proprietary formats. Position Summary: The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of healthcare data between Capital Rx - JUDI Health and its various partners, including employers, providers, and other TPAs.

YEAR

Capital Rx, Inc.

Analyst, Data Exchange - Claim Ops (Tpa)

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Working under general supervision, the PBS Claims Specialist-Denial Management resolves delinquent payment issues of complex (high dollar and specialty) accounts requiring advanced knowledge of multi-payor system. Compiles payer trends regarding denial activity, and reports on collected dollars and appeal review activity for PBS Management and various Legacy Departments wherein denial activity originates.

HOUR

Legacy Health System

PBS Claims Specialist Denial Management

Partners closely with IT, EDI Operations, Finance, Network Management, Compliance, Clinical, Appeals and Grievances, and other business leaders to optimize claims system configuration, edit logic, benefit loading accuracy, provider and contract data integrity, accumulator logic, dispute root cause remediation, operational readiness, provider experience, and downstream member outcomes for new products, regulations, contracts, and enterprise initiatives. Drives affordability through payment integrity, configuration discipline, and disciplined claims controls, including pre-payment and post-payment review, clinical and non-clinical editing, duplicate detection, unbundling, upcoding, billing anomaly detection, provider audits, coordination of benefits, and high-dollar claims review.

SCAN Health Plan

Vice President, Claims and Provider Operations

Apply Medicare-based pricing, Reference-Based Pricing (RBP), fee schedules, resource-based relative value methodologies, diagnosis-related groups, ambulatory payment classifications, per-diem rates, case rates, percent-of-charge arrangements, stop-loss provisions, and other approved reimbursement approaches. Advanced knowledge of procedure, revenue, diagnosis, and modifier logic; physician fee schedules; resource-based relative value methodologies; diagnosis-related groups; ambulatory payment classifications; per-diem, case-rate, percent-of-charge, and other medical reimbursement arrangements.

Lead, Medical Network Claims Pricer

Initially focused on Routine Test Management (RTM), the role will review existing and emerging policies with Scientific Affairs and Coding & Translation, identify opportunities for additional enforcement, translate those opportunities into configuration-ready rule statements, and model financial impact using claims data and approved AI tools. About the Product Owner, Claims Editing Position: The Product Owner, Claims Editing will identify, design, and support implementation of new automated claim edits that generate incremental value and revenue across Avalon's claim-editing programs.

Avalon Health Services LLC

Product Owner, Claims Editing

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. Preferred Qualifications: Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health.

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others.

What we do

Gain insights on how we work to help people live healthier lives and help make the health system work better for everyone by watching this video.

<a href="https://www.youtube.com/watch?v=5PbNyi2IDkY">https://www.youtube.com/watch?v=5PbNyi2IDkY</a> 

Caring. Connecting. Growing together. 

Being a part of UnitedHealth Group means working to improve health outcomes for everyone, including yourself. Here is how:

• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. <a href="https://careers.unitedhealthgroup.com/culture/what-we-offer/">Learn more about what we offer.</a> 

• Connecting. We recognize our collective power to make an impact across our communities because we believe the health of any society is measured by the overall health of its people. <a href="https://careers.unitedhealthgroup.com/culture/">Learn more about our culture.</a> 

• Growing together. UnitedHealth Group is full of inspiring career stories, and we offer a lifetime of opportunities. <a href="https://careers.unitedhealthgroup.com/career-areas/">Discover all the ways you can learn, grow and develop.</a>

UnitedHealth Group Inc

Clinical Claim Review RN

Consent to Communication and Use of AI Technology: By submitting your application for this position and providing your email address(es) and/or phone number(s), you consent to receive text (SMS), email, and/or voice communication whether automated (including auto telephone dialing systems or automatic text messaging systems), pre-recorded, AI-assisted, or individually initiated from Aditi Consulting, our agents, representatives, or affiliates at the phone number and/or email address you have provided. The main function of a business operations specialist is to maintain vendor relationships, acting as a business analyst for non-IT projects or filling organizational roles above an administrative level, but below a management level.

Aditi Consulting

Business Analyst

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Your attention to detail, follow-through, and communication help ensure that payments are received accurately and on time, allowing our teams in the field to stay focused on what matters most: providing exceptional care to our residents. You'll manage the billing and collections process for assigned facilities-from clean, timely claims submission through payment-while partnering with facility teams to resolve issues and keep revenue moving.

Regency Integrated Health Services LLC

Accounts Receivable Analyst

Leveraging our 350-year heritage, MSIG USA brings the financial strength, expertise, and global footprint to offer commercial insurance solutions that address your business's unique risks. The Claims Compliance Analyst supports the Claims Regulatory & Compliance function by monitoring, analyzing, and helping ensure adherence to federal and state claim-related regulatory requirements.

Mitsui Sumitomo Insurance Company Of America

Compliance Analyst

Serve as the primary owner of DOI investigations and responses, including gathering records, developing factual analyses, drafting responses, coordinating required internal review, and submitting approved responses by applicable deadlines. Identify and promptly escalate material legal or regulatory risks, complex or disputed issues, and matters that exceed assigned authority; coordinate complete and timely handoffs to the paralegal team or attorneys.

Goosehead Insurance Inc

Legal Analyst

Leveraging our 350-year heritage, MSIG USA brings the financial strength, expertise, and global footprint to offer commercial insurance solutions that address your business’s unique risks. The Claims Compliance Analyst supports the Claims Regulatory & Compliance function by monitoring, analyzing, and helping ensure adherence to federal and state claim-related regulatory requirements.

MSIG Holdings

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FULL_TIME

As a Analyst, Risk you will: Manage the day-to-day oversight and coordination of casualty claims, including auto liability, general liability, and workers’ compensation claims, and will work closely with third-party administrators (TPAs), insurance carriers, internal business units, and other stakeholders to facilitate timely and effective claim resolution. The Risk Analyst will provide day-to-day oversight and coordination of casualty claims, including auto liability, general liability, and workers' compensation claims, and will work closely with third-party administrators (TPAs), insurance carriers, internal business units, and other stakeholders to facilitate timely and effective claim resolution.

The Friedkin Group

Analyst, Risk

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Requires a minimum of three years previous experience in healthcare (or one year healthcare experience with an associate or bachelor’s degree) with two years of claim experience in hospital billing with complete familiarity of the third-party billing and collection process. The Recovery Reimbursement Analyst I is responsible for managing and resolving outstanding insurance claims, including denials, unadjudicated balances with no payer response and claims requiring technical appeal submissions for technical hospital claims.

Halifax Health

Recovery Reimbursement Analyst

Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments. Quality Improvement Research Analyst - Minimum Qualifications: Minimum years of relevant work experience: 3+ years' in a relevant healthcare field - claims processing, claims coding, customer service, and/or account management.

Quality Improvement Research Analyst

Working closely with Revenue Cycle Operations, Patient Financial Services, Clinical Operations, Information Services, and operational leadership, the analyst gathers business requirements, translates operational needs into technical solutions, and implements workflow enhancements that improve billing accuracy, reimbursement performance, and overall revenue cycle effectiveness. The analyst configures and supports Epic Professional Billing functionality, including claims processing, electronic claims submission, electronic remittance advice (ERA), charge review, payer configuration, benefits integration, billing work queues, reimbursement workflows, and revenue cycle automation.

Hill Physicians Medical Group Inc

Application Analyst III - Epic Revenue Cycle (Professional Billing) - Hybrid (Remote Considered) - 26-108

They must be able to exercise judgement/decision making on complex payment decisions that directly impacts the provider and UHC/Client by following state and government compliance guidelines, coding requirements and policies. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

C&S Clinical Coding Analyst

Produces and monitors key performance metrics, including: Percent of cases settled pre-IDR, averaged negotiated rate versus initial offer, percent of negotiations escalated to IDR, provider acceptance rate, IDR award versus QPA, IDR win rate, win rate by arbitrator, etc. Develops visual dashboards that summarize OON dispute performance, financial impact, and strategic opportunities; creates executive-ready reporting materials for leadership reviews and governance forums; develops drill-down capability from enterprise-level performance to market, provider, specialty and case-level detail.

Claims Analyst Jobs in the United States

Senior Claims Representative Analyst Society Insurance

Claims Examiner South Florida Community Care Network

Billing, Coding, and Claims Resolution Specialist Phaxis

Analyst, Data Exchange - Claim Ops (Tpa) Capital Rx, Inc.

PBS Claims Specialist Denial Management Legacy Health System

Vice President, Claims and Provider Operations SCAN Health Plan

Lead, Medical Network Claims Pricer Capital Rx, Inc.

Product Owner, Claims Editing Avalon Health Services LLC

Clinical Claim Review RN UnitedHealth Group Inc

Business Analyst Aditi Consulting

Accounts Receivable Analyst Regency Integrated Health Services LLC

Compliance Analyst Mitsui Sumitomo Insurance Company Of America

Legal Analyst Goosehead Insurance Inc

Compliance Analyst MSIG Holdings

Analyst, Risk The Friedkin Group

Recovery Reimbursement Analyst Halifax Health

Quality Improvement Research Analyst Avalon Health Services LLC

Application Analyst III - Epic Revenue Cycle (Professional Billing) - Hybrid (Remote Considered) - 26-108 Hill Physicians Medical Group Inc

C&S Clinical Coding Analyst UnitedHealth Group Inc

Senior Analyst, Data & Analytics - No Surprises Act/Provider Reimbursements/SQL - Remote Molina Healthcare Inc

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