Claims analyst jobs in New York, New York - Page 3Create job alerts

The Senior Stop Loss Claims & Cost Containment Analyst supports the Accident & Health (A&H) team by serving as a forward-facing liaison to cost containment vendors and customers while also providing hands-on support to stop loss and reinsurance claims operations. As a key contributor on this highly

Serve as claim processing subject matter expert for resolution of issues related to claims processing and adjudication outcomes for medical, hospital, dental claims for all EmblemHealth lines of business as requested by EmblemHealth business partners or CTS business partners. Ensure impacted claims

The team serves as a claims technical resource, as well as provides assistance and expertise across Hiscox by identifying and promoting claims best practices and facilitating required improvements. This is a high-impact role suited for an experienced insurance claims compliance professional or attor

The ability to influence claims and non-claims stakeholders by effectively directing claims strategy. Join us as a Claims Analyst III to take on key responsibilities within a world-class claims function. As a Claim Analyst III, you will be responsible for handling all aspects of multi-line, financia

HealthCare Claims Analyst Join VillageCare as a Full-Time HealthCare Claims Analyst and take your career to the next level while working from the comfort of your home. The Full-Time HealthCare Claims Analyst position at VillageCare requires a seasoned professional with a minimum of five years of exp

SUNSHINE ENTERPRISE USA LLC is looking for an experienced Business Analyst specializing in policy remediation with expertise in medical coding and healthcare claims systems. This remote position requires strong knowledge of ICD-10, CPT, and HCPCS coding methodologies, along with 5+ years of relevant

VillageCare of New York is seeking a Full-Time HealthCare Claims Analyst to work from home. Candidates should have a minimum of five years of experience in healthcare claims and strong SQL and Excel skills.

SUNSHINE ENTERPRISE USA LLC is looking for an experienced Business Analyst specializing in policy remediation with expertise in medical coding and healthcare claims systems. This remote position requires strong knowledge of ICD-10, CPT, and HCPCS coding methodologies, along with 5+ years of relevant

Warranty Administration, Service Advisor/Service Writer, Warranty Clerk/Warranty Analyst, Fixed Operations/Service Department. Our client is seeking experienced automotive professionals with strong warranty claims and dealership fixed‑operations knowledge to support a nationwide warranty complianc

Job Summary: We are seeking an experienced Epic Billing Analyst to manage and optimize Epic Resolute Professional Billing (PB) and Hospital Billing (HB) systems. Key Responsibilities: Configure, maintain, and optimize Epic PB/HB modules: charge routing, work queues, statements, claims, and collectio

Job Description Hi, we're Oscar. We're hiring a SIU Investigator to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The SIU Investigator identifies and investigates aberrant behavior observed in medical claims data and member enrollment data. You will manage an investigative caseload from case identification through to resolution, including data mining, investigation planning, data analysis, sampling, medical records requests, audit interpretation, overpayment recovery, reporting to regulatory agencies and monitoring ongoing provider behavior. The Senior Analyst will meet metrics set forth related to caseload, turn around times, and other unit-wide goals. You will report into the Investigations Manager, SIU. Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote / work-from-home role. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. The base pay for this role in the states of New Jersey and New York is: $72,036 - $94,546 per year. The base pay for this role in all other locations is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Identify and conduct investigations into suspected FWA with high autonomy, • Document findings to include formal investigative reports, tables, graphs, audit logs, and other supporting documentation, • Met metrics to align with caseload, turn around times, and other unit-wide goals, • Continue to monitor providers with substantiated findings to track behavior change, • Participate in the development and presentation of FWA-related education for Oscar teams, • Build evidentiary files for potential recovery, legal action, and/or referrals to appropriate outside agencies, • Compliance with all applicable laws and regulations, • 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies, • Bachelor's degree in Criminal Justice or a related field, • Experience with HIPAA, data privacy, and/or data security processes, • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

A fast-paced healthcare company in New York is seeking a Quality Analyst to manage the medical file review process and ensure excellence in client interactions.

A minimum of one year of experience as an Epic Hospital Billing Claims Analyst. 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

JOB SUMMARY The Quality Analyst is responsible for managing the various aspects of the medical file review process. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Ma

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. A minimum of one year of experience as an Epic Professional Billing

Serve as claim processing subject matter expert (SME) for resolution of issues related to claims processing and adjudication outcomes for medical, hospital, dental claims for all EmblemHealth lines of business as requested by EmblemHealth business partners or CTS business partners. Strong knowledge

Evaluate disputed claims for system configuration, claims processing, and/or contractual issues to facilitate claims review. Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines. Maintain and organize de

Claims And Credentialing Analyst. The Claims and Credentialing Analyst will be a pivotal role in analyzing and coordinating all activities of the Provider Data team by evaluating and refining processes, conducting comprehensive data analysis, and ensuring compliance with all applicable State, CMS, c

Evaluate disputed claims for system configuration, claims processing, and/or contractual issues to facilitate claims review. Maintain and organize detailed information on claims dispute files to ensure appropriate and comprehensive data is returned to the provider timely. Identify potential/actual c

Claims Analyst, Environmental Casualty. Job Summary: Investigate, evaluate, and resolve claims asserted against the Company's environmental policies. Efficiently manage a vigorous load of claims involving a broad spectrum of accounts and coverages.

As a Claims Analyst IV, you will be responsible for handling Financial Institutions Claims, which encompasses claims involving Employment Practices, Fiduciary Liability, and Director & Officers. As a Claims Analyst IV, you will be responsible for identifying, investigating, and resolving multiple co

Accurately administer and validate claims in the e-claims system, including application of claims reserves, documentation, and recovery. The Senior Logistics Liability Claims Analyst is responsible for professionally managing logistics liability claims across the U. Manage mid to high value logistic

Under the supervision of the Manager of Health Fund Operations, the Claims Dispute Resolution Analyst will be responsible for reviewing healthcare claims flagged under the "lesser of terms" payment principle and managing cases within the Independent Dispute Resolution (IDR) process. Claims Dispute R

As a Claims Analyst III, you will be responsible for handling claims from inception through conclusion of Professional Liability matters, including Cyber, Network Security, Business Interruption, Media and Technology exposures and be responsible for investigating & evaluating coverage, analyzing lia

As a Claims Analyst IV, you will be responsible for handling Employment Practices Liability with opportunity to handle Director & Officers and Fiduciary Liability Claims, identifying, investigating, and resolving multiple coverage issues at the earliest appropriate time and providing clear and conci

The Claims Analyst is responsible for researching, analyzing, and resolving complex claim-related inquiries from internal teams and external partners, including providers and ancillary laboratories. Review and validate our claims processor's weekly reports to ensure claims are adjudicated according

The Claims and Encounter Analyst II enhances the efficiency and effectiveness of the claims department by analyzing data, refining processes, and ensuring compliance with State, CMS, and contractual guidelines. Claims And Encounter Analyst II. Claims adjudication and understanding of claims PPS is s

A minimum of four (4) years of experience handling liability insurance claims or related relevant experience, including General Liability claims in the construction context (Construction Defect) and Casualty claims, with specific experience handling New York Labor Law matters. Claims Analyst, Primar

The successful candidate will be the initial point of contact for surety bond claims and have primary responsibility for the distribution of claims, correspondence and other materials received by the surety claims department and providing other support services as identified below. Claims Services S

As a Hartford Global Specialty - Financial Lines entry level Claims Analyst in our Employment Practices Liability ("EPL") unit, you will be responsible for handling an inventory of claims-made, large company, middle market and small commercial EPL claims, many of which are Charges with the Equal Emp

Business Intelligence & Data Analyst. We're looking for an analytically strong, hands-on BI & Data Analyst with 3-5 years of experience turning data into decisions.

Notify billing staff promptly of any verification issues that may prevent claims from being billed within the required 7-day turnaround from Date of Service (DOS). Monitor ongoing claims to verify continued eligibility, resolve discrepancies, and follow up with carriers and attorneys as needed. Insu

Requires a High school diploma or GED; up to 2 years’ experience working in grievances and appeals, claims, or customer service or any combination of education and/or experience which would provide an equivalent background. Reviews, analyzes and processes non-complex grievances and appeals in acco

Reviewing medical insurance claims for resolution and payment in a timely manner for maximum reimbursement. A Claims Resolution Specialist ensures the outstanding revenue for services provided by home health and hospice agencies is collected and reimbursed appropriately.