UNKNOWN

FEED

Reporting to the Chief Technology Officer, this senior leader role establishes the enterprise data architecture that enables operational excellence, financial transactions, external partner connectivity, regulatory compliance, analytics, and artificial intelligence. The position leads enterprise data architecture, data governance, enterprise integration services, and enterprise data platform, including responsibility for EDI, client extracts, file-based integrations, APIs, and external partner connectivity.

Centivo

VP Data Architecture & Integration

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The resident contributes to formulary management, clinical programs, benefit operations, utilization management, analytics, client support, and strategic business initiatives for commercial, Medicare, Medicaid, and health insurance marketplace 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.

YEAR

Capital Rx LLC

PGY1 Managed Care Resident

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Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and. As an Account Manager focused on PBA and Medicare, you''ll be at the forefront of delivering seamless client experiences by managing benefit changes, implementing new plans, and ensuring pricing accuracy-all while driving impactful solutions that directly shape business success.

Account Manager, PBA

In this detail-oriented and customer-focused role, you will work closely with eligible parties, medical providers and attorneys to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process. Proactively manage medical treatment based on the nature and extent of injury, mechanism of injury, type of treatment received or anticipated, and wage loss through case management and use of medical resources as needed.

The Travelers Companies

Auto First Party Medical Claim Representative

The Project Manager is responsible for maintaining project governance, tracking milestones, managing risks and dependencies, facilitating stakeholder communication, and supporting continuous improvement initiatives that strengthen the organization''s compliance program. 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.

Senior Project Manager, Business Continuity

Elicit, document, validate, and translate business needs into High-Level Requirements (HLRs), Detailed Business Requirements (DBRs), business rules, user stories, and acceptance criteria using IBM ELM and ServiceNow. About CTG CTG, a Cegeka company, delivers IT and business solutions that enhance clients' digital agility, empowering them to seize new opportunities and overcome any challenge.

HOUR

CTG (NASDAQ: CTG) provides industry-specific IT services and solutions that address the business needs and challenges of clients in high-growth industries in North America and Western Europe. CTG also provides strategic staffing services for major technology companies and large corporations. Backed by more than 50 years of experience and proprietary methodologies, CTG has a proven track record of reliably delivering high-value, industry-specific staffing services and solutions to its clients. CTG has operations in North America, Western Europe, and India.

 

CTG's greatest asset is its people, and as such, we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work in Healthcare company by Modern Healthcare (2013-2016) in North America, and a Best Workplace in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).
 
CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws. 
 
CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.

Computer Task Group, Inc

Healthcare Business Analyst / Systems Analyst

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. The ideal candidate will have a strong background in executing analytics projects, collaborating with cross-functional teams, and presenting actionable insights to support business decisions.

Senior Analyst, Analytics - Corporate Insights

With general direction of the Manager/Supervisor/Lead: Follows department policies and procedures and maintains and exercises thorough knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivables, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services. Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 910402 United Business Office Work Shift: UR - Day (United States of America) Range: UR URCC 204 H Compensation Range: $19.72 - $26.62

University of Rochester

Clm Resltion Rep II, Hosp/Prv

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Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and. Position Summary: The Account Manager, PBM is responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, and new implementations.

Account Manager, PBM

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. Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and.

Analyst, Data Exchange - Claim Ops TPA

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. Owns and manages the overall company strategy as it pertains to Insured Products and the various market offerings including but limited to; Stop Loss, Reinsurance, Captive Management, Level Funded and MEC programs.

VP, Insured Products

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. Act as the quarterback of the broader account team, providing leadership across internal partners and ensuring clarity on roles, priorities, deliverables, and client commitments.

Account Executive, PBM

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. Develop and execute effective sourcing strategies to identify and engage passive technical candidates through various channels, including LinkedIn Recruiter, GitHub, internal databases, networking, etc.

Recruiter Contract

This role helps ensure programs are executed effectively and efficiently; stakeholders remain informed, and both clients and members receive timely, high-quality support involving clinical programs involving clinical vendor partners. The Clinical Programs Specialist provides operational and administrative support for the day-to-day management of clinical programs and clinical vendor partnerships under the direction of the Clinical Programs Specialists Manager.

Clinical Programs Specialist

The ideal candidate combines strong legal operations experience and project management capabilities with technical proficiency, sound business judgment, and a demonstrated track record of leveraging AI, workflow automation, and technology solutions to improve productivity, reduce risk, enhance service delivery, and support rapid organizational growth. This individual will serve as a strategic partner to the General Counsel and legal leadership team, driving efficiency, scalability, data-driven decision making, and the adoption of artificial intelligence and automation tools across legal and compliance functions.

Director, Legal Operations

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. Judi Health replaces fragmented, outdated systems with the industry''s first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform.

Recruitment Coordinator Contract

Developer - Atlassian Process Engineering

We want people who like working in a collaborative team environment and enjoy creating practical, efficient, and high-performance software that leverages Large Language Models (LLM), Multimodal Language Models(MLM), and other ML models and techniques to build amazing capabilities for our customers, partners, and employees. 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.

Senior Machine Learning Engineer II

As a Staff Applied Scientist, you will play a crucial role in developing, improving, and exploring the capabilities of multimodal LLMs to solve complex real-world problems geared towards building automation and Conversational AI products enabling increased productivity and magical experiences for our customers. We want people who like working in a collaborative team environment and enjoy creating practical, efficient, and high-performance software that leverages Large Language Models (LLM), Multimodal Language Models(MLM), and other ML models and techniques to build amazing capabilities for our customers, partners, and employees.

Staff Applied AI/ML Scientist

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. This individual will be involved in supporting building robust, scalable, and accurate data systems that empower operational and analytics teams to make informed decisions and drive positive outcomes.

Claims Processor Jobs in New York

VP Data Architecture & Integration Centivo

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Account Manager, PBA Capital Rx LLC

Auto First Party Medical Claim Representative The Travelers Companies

Senior Project Manager, Business Continuity Capital Rx LLC

Healthcare Business Analyst / Systems Analyst Computer Task Group, Inc

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Clm Resltion Rep II, Hosp/Prv University of Rochester

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VP, Insured Products Capital Rx LLC

Account Executive, PBM Capital Rx LLC

Recruiter Contract Capital Rx LLC

Clinical Programs Specialist Capital Rx LLC

Director, Legal Operations Capital Rx LLC

Recruitment Coordinator Contract Capital Rx LLC

Developer - Atlassian Process Engineering Capital Rx LLC

Senior Machine Learning Engineer II Capital Rx LLC

Staff Applied AI/ML Scientist Capital Rx LLC

Data Engineering Intern Part Time Capital Rx LLC

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