UNKNOWN

FEED

Position 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 Claims Ops (Tpa)

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Track progress against substantiation-rate and findings-volume targets (set once POC window and initial data are confirmed). Our Client, an American Technology company, is looking for a Senior SIU Analyst - FWA Detection for their Bowie, MD location.

Iconma LLC

Senior SIU Analyst - FWA Detection

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Designs, develops, and maintains reports, dashboards, and data solutions using tools such as Structured Query Language (SQL), Microsoft Excel, and SQL Server Reporting Services (SSRS), that support utilization analysis, cost-containment, and operational performance. Partners with stakeholders to define requirements, develop scalable reporting and data processes, and apply advanced analytical techniques to identify trends, forecast outcomes, and drive business performance.

Molina Healthcare Inc

Senior Analyst, Provider and Claim Data & Analytics (Remote)

FULL_TIME

Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Company Overview: At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents.

Enlyte

Senior Liability Claims Analyst

[AW]-iCims

CONDUCTS complex analyses of processes, documentation, and controls; SUPPORTS state requested regulatory quality reviews; and works in a solution-oriented manner to identify and support effective resolutions. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations.

GEICO GENERAL INSURANCE COMPANY

Commercial Quality Assurance / Technical Analyst

Incorporating industry-leading preconstruction and construction services, the Companys multi-disciplined team of engineering and construction professionals delivers a wide range of projects, including new facilities, infrastructure improvement and expansion, and capital construction services. With the ultimate goal of delivering maximum value to clients and their local communities, MWH Constructors provides single-source, integrated design and construction services through a full range of project delivery methods.

Slayden Constructors Inc

Senior Construction Claims Analyst

We measure our long-term success on our ability to deliver value for shareholders, meet customer needs, attract, and develop the best talent in our industry, offer an inclusive work environment where employees can develop to their full potential and give back to the communities where we live and work. For over 150 years, Prudential's diverse and talented employees have been committed to helping employees and their families grow and protect their wealth through a variety of products and services, including Group Disability Insurance.

Prudential Financial Inc

Team Lead, Long-Term Disability Claims

At the core of this role is deep, practical experience in claims management: overseeing the full claims lifecycle, driving financial recovery, managing carrier relationships, and building high-performing teams that consistently deliver results across both final mile and parcel claim types. Leverage AI-driven analytics and predictive modeling to forecast claim volumes, identify high-risk carriers or routes, optimize resource allocation, and proactively surface trends before they become financial liabilities.

Samsung Electronics America Inc

Claims Sr Manager

You will be working closely with the business team comprising of business analysts, business owners, QA team as well as IT team members like applications Architect, developers, product and project managers and other team members. As Systems Analyst, it is required you bring strong technical skills and experience of performing Systems Analysis for various product initiatives and build a backlog of systems requirements that can be assigned to various developers.

Health Care Service Corp

Sr Systems Analyst

This role is responsible for executing and monitoring outbound eligibility, claims, formulary, and network reporting; supporting manual claims activities; assisting with custome data feed configurations; and participating in historical data loads and connectivity setups for JUDI Rx clients. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

Analyst, Data Exchange - Claims Operations

The claims escalation analyst monitors liability claims from start to finish, verifying and updating information on submitted claims, reviewing the policy to determine which charges are eligible for reimbursement, reconciling a claims adjuster's estimates, negotiating payment to all parties and following up to ensure that payments are made. Accurately evaluates each account in order to determine what is needed, what is left outstanding and what steps are necessary to resolve the account quickly.

Lake Charles Memorial Health System

Claims Escalation Analyst

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The Analyst uses established Power BI reports to analyze payor adherence to contracted fee schedules, recognizes patterns of incorrect payment, and leads project-level remediation efforts covering underpayments, incorrect claims adjudication, credentialing-related issues, and payor policy misapplication. The Analyst prepares the reporting and data files that drive payor remediation projects and works closely with Revenue Cycle leadership, FP&A, Accounts Receivable management, billing, and credentialing to recover underpayments, resolve payor issues, and implement forward-looking process improvements.

Optima Dermatology

Payor Reimbursement & Claims Remediation Specialist

Works closely with others to gain strong understanding of insurance concepts such as financial P&Ls, expense ratios, rate level indications, loss ratio trends, and marketing funnel metrics and to get familiar with internal workflows (i.e. underwriting, sales and claims handling). The Business Intelligence Analyst supports the analysis of operational workflows and lifetime profitability to measure operational and marketing channel effectiveness and ensure adequate profitability for the business being written by the Direct Group.

Plymouth Rock Management Company of New Jersey

Business Intelligence Analyst

Job Responsibilities: Lead the encounter data error identification effort and coordinate error resolutions with the external vendors and clients as well as key internal departments (i.e. claims, enrollment, provider, IT etc.). Network Health is seeking an Encounter Data Analyst to support the critical encounter data functions for our Medicaid TPA line of business.

Network Health LLC

Encounter Data Analyst

Analyst plays a crucial role in ensuring that customer issues are promptly identified, thoroughly understood, and effectively addressed, ultimately contributing to improved product quality, customer satisfaction, and brand loyalty. Proactively seeking feedback from stakeholders, including customers and internal teams, to identify areas for improvement and refine processes for capturing and addressing customer concerns.

Control Tower Pre Analyst

The engineering analyst also provides technical direction and support to maintain electric delivery systems as well as conducts operational and cost benefit studies, surveys and research to support development or revision of objectives, policies, practices and programs, participates in major cost and process improvement initiatives and projects, and provides technical support in managing the business unit''s financial performance. Initiate and deliver principal support to complex engineering distribution operations, and schedulers in areas such as end user support, software development, implementation, testing, operation and maintenance for transmission and distribution computer systems used for delivery services.

Berkshire Hathaway Energy Co

Engineering Analyst/Senior Engineering Analyst

MS Reinsurance is the market-facing brand of the risk carrying legal entity MS Amlin AG, a global reinsurer domiciled in Switzerland and operating in Bermuda as MS Amlin AG, Bermuda Branch, in the United States through MS Amlin Reinsurance Managers, Inc, and in Labuan, Malaysia as MS Amlin AG, Labuan Branch.” . As part of the world-leading insurance group MS&AD, MS Reinsurance is a trusted, long-term partner, helping clients turn risks into opportunities through deep technical expertise and bespoke reinsurance solutions.

MS Amlin Reinsurance Managers

Pricing Analyst

Network Health

Medicaid Encounter Data Analyst (Remote Position In WI)

Bachelor’s degree in risk management, Insurance, Finance, Business, or related field; JD, MBA, or advanced designation (ARM, CPCU, CRIS) a plus. 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.

Pyramid Consulting, Inc

SENIOR RISK ANALYST

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In addition to these tasks, the Senior Claims Analyst is responsible for all of the same tasks as a Claim Analyst including the accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups. Minimum Requirements: Minimum three-years life and/or disability claim administration experience: solid investigation, analytical and organizational skills along with attention to detail; or the equivalent combination of relevant experience.

Claims Analyst Jobs in the United States

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

Senior SIU Analyst - FWA Detection Iconma LLC

Senior Analyst, Provider and Claim Data & Analytics (Remote) Molina Healthcare Inc

Senior Liability Claims Analyst Enlyte

Commercial Quality Assurance / Technical Analyst GEICO GENERAL INSURANCE COMPANY

Senior Construction Claims Analyst Slayden Constructors Inc

Team Lead, Long-Term Disability Claims Prudential Financial Inc

Claims Sr Manager Samsung Electronics America Inc

Sr Systems Analyst Health Care Service Corp

Analyst, Data Exchange - Claims Operations Capital Rx, Inc.

Claims Escalation Analyst Lake Charles Memorial Health System

Payor Reimbursement & Claims Remediation Specialist Optima Dermatology

Business Intelligence Analyst Plymouth Rock Management Company of New Jersey

Encounter Data Analyst Network Health LLC

Control Tower Pre Analyst Iconma LLC

Engineering Analyst/Senior Engineering Analyst Berkshire Hathaway Energy Co

Pricing Analyst MS Amlin Reinsurance Managers

Medicaid Encounter Data Analyst (Remote Position In WI) Network Health

SENIOR RISK ANALYST Pyramid Consulting, Inc

Sr Claims Analyst - LHB HCSC

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