medical claims analyst

Prairie States Enterprises, Inc.

<div>
 
 MEDICAL CLAIMS ANALYST (FULL-TIME / REMOTE / HYBRID)
 
 
 
 
 This is a full-time position with a hybrid remote work arrangement in our Sheboygan, WI location. No weekends, holidays or on-call rotations. Ideal candidate will work in Wisconsin.
 
 
 
 Prairie States Enterprises, Inc. is a third party administrator, a benefits industry leader, and a trusted advisor to self-insured companies and their employees. We provide a complete range of medical benefit management services, all performed in-house, and to exacting standards of excellence.
 
 
 
 Job Summary
 
 
 
 Position responsibilities include the adjudication and processing of medical, dental, and vision claims while interpreting coding and medical terminology in relationship to the diagnosis and medical procedures. This position requires high level skills in customer service, claims processing, and internal interface with other departments
 
 
 
 Summary Of Essential Job Functions
 
 
 
 <ul>
 <li>
 Provides claims adjudication services by reviewing, researching, investigating, adjudicating and processing claims for assigned relationships.
 </li>
 <li>
 Provides high-level customer service when interacting with members, Human Resource contacts, employees, providers, and internal staff.
 </li>
 <li>
 Has the ability to read and comprehend instructions and draft short correspondence, and memos. Also has the ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
 </li>
 <li>
 Understands all aspects of plan documents for assigned groups, and groups within their assigned pod.
 </li>
 <li>
 Demonstrates understanding of electronic claims from exceptions to pass-through audits. Should also be able to identify potential large claims and have a good understanding of the stop-loss process and pend claims appropriately.
 </li>
 <li>
 Performs daily duties and processes claims with minimal direction and asks questions appropriately.
 </li>
 <li>
 Is responsible and accountable for the accurate and timely entry of claims data. Claims data must be entered with a high level of quality and in accordance with department claims policies and procedures.
 </li>
 <li>
 Consistently meets established productivity and quality standards:
 </li>
 <ul>
 <li>
 Minimum turn-around time is 10 days for clean claims. Claims requiring further investigation will be paid within 1 month unless extenuating circumstances arise and are documented.
 </li>
 <li>
 Once additional information is received, claims must be paid within 10 days from receipt of the documentation.
 </li>
 <li>
 Required to meet the department standards related to procedural and financial accuracy.
 </li>
 </ul>
 <li>
 Assists in answering overflow of outside phone calls, directing the call to the appropriate person or handling the call if that person is not available.
 </li>
 <li>
 Other Claims Dept duties and special projects as assigned.
 
 
 </li>
 </ul>
 
 Position Requirements
 
 
 
 <ul>
 <li>
 High School Diploma or GED required. Post HS education in medical field and medical terminology highly preferred.
 </li>
 <li>
 Experience &ndash; 1 to 3 years experience in an insurance or medical office setting.
 </li>
 <li>
 Strong customer service and communication skills required.
 
 
 
 </li>
 </ul>
 
 COMPETENCIES
 
 
 
 <ul>
 <li>
 Change Management &ndash; Accepts, supports, and executes assignments in conditions of change which support attaining department goals.
 </li>
 <li>
 Effective Communication &ndash; Demonstrates effective and responsive communications following the appropriate reporting structure.
 </li>
 <li>
 Accountability/Results &ndash; Achieves and/or exceeds result based goals that were specific, measurable, and timely.
 </li>
 <li>
 Teamwork &ndash; Demonstrates teamwork behaviors and makes positive contributions and which support the achievement of department goals.
 </li>
 <li>
 Customer Satisfaction &ndash; Dedicated to the PSE service model and meets or exceeds PSE customer satisfaction expectations in providing exemplary service.
 </li>
 <li>
 Professional Growth &ndash; Takes ownership of one&rsquo;s professional growth within one&rsquo;s current position and to advancement at PSE.
 
 
 
 </li>
 </ul>
 
 PHYSICAL DEMANDS / WORK ENVIRONMENT
 
 
 
 This is sedentary position which requires the individual to sit for long periods of time and the proper positioning/posturing for extensive viewing of computer screens and computer related work is required. It is encouraged that individuals intermix this sedentary time with periodic movement within one&rsquo;s office space and/or to other office areas to counteract the sedentary nature of this position.
 
 
 The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
 
 
 To the selected candidate, we offer:
 
 
 
 Competitive compensation based on experience and a comprehensive benefit package provided to include Medical, Dental, Vision, Life, STD/LTD, FSA, Paid Time Off, personal days, 401k with match, wellness and exercise membership and more. Click HERE to view our full-time benefits flyer.
 
 
 Opportunity for meaningful career growth within a results-driven company and our company culture is one of ambition, integrity, empowerment, teamwork and a passion for personal and company success.
 
 
 If this sounds like you and you&rsquo;re seeking career growth with an exciting new career path in overseeing the quality of health care for our clients and their members, please send your cover letter and resume following the instructions for this site.
 
 
 Prairie States Enterprises
 
 
 Equal Opportunity Employer
</div>

Medical Claims Analyst (full-time / remote / hybrid)

Amerit Consulting

<div>
 
 
 
 OVERVIEW:
 
 
 
 
 
 Our client, a US Fortune 50 organization and a leading provider of Healthcare and Health Insurance services
 
 , seeks an accomplished
 
 Medical Claims Specialist
 
 .
 
 
 
 
 
 
 
 IMPORTANT NOTES: REMOTE / WORK-FROM-HOME RELATED:
 
 
 
 <ul>
 <li>
 
 This will be a Remote role.
 
 </li>
 <li>
 
 Equipment's will be provided.
 
 </li>
 <li>
 MUST have high-speed wired Internet connection. Wi-Fi / Wireless connections are not allowed.
 </li>
 <li>
 MUST have a reliable home-office environment.
 </li>
 <li>
 
 Payrate would be $18.15 per hour. The worker must also receive an additional $5.55 per hour payment in lieu of benefits. Total hourly Pay rate would be $23.70 per hour.
 
 </li>
 <li>
 
 Training Shift Hours: 40 hours per week | 08:00am to 4:30pm (Eastern Time).
 
 </li>
 <li>
 
 Training will be 5-6 weeks.
 
 </li>
 <li>
 
 After training, the candidates may choose to flex start time of 6:00 AM to 10:00 AM (Eastern Time).
 
 </li>
 </ul>
 
 
 
 
 
 
 Client will be considering candidates MUST sit within 50 miles of below location (Please apply accordingly):
 
 
 
 <ul>
 <li>
 Dennison, TX
 </li>
 <li>
 Atlanta, GA
 </li>
 <li>
 Midland/Columbus, GA
 </li>
 <li>
 Indianapolis, INDIANA
 </li>
 <li>
 Louisville, KY
 </li>
 <li>
 Gilbert, MN
 </li>
 <li>
 St Louis, MO
 </li>
 <li>
 Winston-Salem, NC
 </li>
 <li>
 Cincinnati, OH
 </li>
 <li>
 Columbus, OH
 </li>
 <li>
 Mason, OH
 </li>
 <li>
 Nashville, TN
 </li>
 <li>
 Norfolk, VA
 </li>
 <li>
 Richmond, VA
 </li>
 <li>
 Roanoke, VA
 </li>
 <li>
 Baltimore, MD
 </li>
 </ul>
 
 
 
 
 
 
 Responsibilities:
 
 
 
 <ul>
 <li>
 This is an entry level position in the NGS Appeals Department that reviews, analyzes and
 
 processes non-complex pre-service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (Part A &amp; B)
 
 related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.
 </li>
 <li>
 Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language.
 </li>
 <li>
 Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
 </li>
 <li>
 The grievance and appeal work are subject to applicable accreditation and regulatory standards and requirements.
 </li>
 <li>
 As such, the analyst will strictly follow department guidelines and tools to conduct their reviews.
 </li>
 <li>
 Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.
 </li>
 <li>
 Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
 </li>
 <li>
 The analyst may serve as a liaison between grievances &amp; appeals and /or medical management, legal, and/or service operations and other internal departments.
 </li>
 </ul>
 
 
 
 
 
 
 Required Qualifications:
 
 
 
 <ul>
 <li>
 
 Must have High School Diploma or GED.
 
 </li>
 <li>
 
 Must have 3-4 years&rsquo; experience working with Medical Claims, grievances and appeals, Medicare, Part A OR PART B.
 
 </li>
 <li>
 
 Familiarity with medical terminology, demonstrated business writing proficiency.
 
 </li>
 <li>
 Must have strong understanding of provider networks, the
 
 medical management process
 
 ,
 
 claims processing
 
 .
 </li>
 <li>
 Must be proficient handling
 
 high volume
 
 
 inbound calls
 
 .
 </li>
 <li>
 Must have background in
 
 following up with insurance providers
 
 .
 </li>
 </ul>
 
 
 
 
 
 
 I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.
 
 
 
 
 
 
 
 
 
 
 
 Recruiter Contact Info
 
 
 
 Jatin Rattan
 
 
 E-mail: jatin.rattan@ameritconsulting.com
 
 
 www.ameritconsulting.com
 
 
 
 
 
 
 I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.
 
 
 
 
 
 
 
 Company Overview:
 
 
 
 Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally; as well as small to mid-sized organizations on a local &amp; regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients&rsquo; businesses forward.
 
 
 
 
 
 Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
 
 
 
 
 
 This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.
 
</div>

Medical Claims Specialist

Gainwell Technologies LLC

<div>It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.<div><div><div><h2 class="jobSectionHeader"> 
Summary</h2></div><div>
The Professional Claims Analyst is responsible for analyzing insurance and matured endowment claims to ensure compliance with organizational standards, client requirements, and applicable regulatory guidelines. In this role, you will evaluate claims trends, assess financial reporting practices, and identify opportunities to improve claims systems and operational processes. This position requires strong analytical expertise, sound judgment, and a thorough understanding of claims procedures and industry standards.</div></div><div><div><h2 class="jobSectionHeader">
Your role in our mission</h2></div><div><ul><li>
Analyze insurance and matured endowment claims to ensure compliance with internal policies, client requirements, and government regulations.</li><li>
Monitor and evaluate claims trends to promote equitable and consistent claims processing practices.</li><li>
Conduct detailed investigations of claims systems and workflows to identify process improvement opportunities and recommend solutions.</li><li>
Review claims financial reporting and reconciliation practices, identifying discrepancies and recommending corrective actions.</li><li>
Inform leadership of potential liabilities, risk exposures, or operational enhancements related to current claims practices.</li></ul></div></div><div><div><h2 class="jobSectionHeader">
What we're looking for</h2></div><div><ul><li>
Bachelor&rsquo;s degree in insurance, business administration, or a related field, or an equivalent combination of education and experience.</li><li>
Minimum of three (3) years of claims experience, preferably within life and disability insurance environments.</li><li>
Experience working with industry-standard claims processing systems and investigative tools.</li><li>
Knowledge of claims processing procedures, documentation standards, administrative guidelines, and relevant legislative requirements.</li><li>
Strong analytical, problem-solving, and communication skills with the ability to evaluate complex claims scenarios.</li></ul></div></div><div><div><h2 class="jobSectionHeader">
What you should expect in this role</h2></div><div><ul><li>
Office-based work environment with collaboration across claims, compliance, and leadership teams.</li><li>
High level of responsibility in reviewing sensitive financial and personal data while maintaining strict confidentiality.</li><li>
Opportunities to contribute to continuous improvement initiatives that enhance claims accuracy, reporting, and operational efficiency.</li><li>
Reliable high-speed internet connection required for remote connectivity when applicable, with minimum download speed of 25 Mbps and upload speed of 10 Mbps.</li><li>
Access to Gainwell&rsquo;s comprehensive benefits package in accordance with eligibility guidelines, including medical, dental, vision, 401(k), and other employee programs</li></ul></div></div></div> 
The pay range for this position is $47,000.00 - $67,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You&rsquo;ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. 
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You&rsquo;ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. 
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.</div>

Professional Claims Analyst - Remote US

Everest Re Group

<div>Company:
Everest Insurance Company
Job Category:
Claims
Job Description:
About Everest:
Everest is a global leader in risk management, rooted in a rich, 50+ year heritage of enabling businesses to survive and thrive, and economies to function and flourish. We are underwriters of risk, growth, progress and opportunity. We are a global team focused on disciplined capital allocation and long-term value creation for all stakeholders, who care deeply about our impact on communities and the wider world.
Job Summary:
Everest Insurance, a member of Everest Re Group, Ltd., is seeking an investigative, detail‑driven Claims Data Research Analyst to join our growing team in either our Warren, NJ or Philadelphia, PA office. This is a hybrid position working 3 days onsite, 2 remote.
In this role, you will transform complex datasets into actionable insights that help drive strategic decision‑making across the Claims organization. If you enjoy solving data challenges, uncovering trends, and influencing business outcomes, this is an exciting opportunity to make a meaningful impact.
You&rsquo;ll work closely with Claims leaders, IT partners, and cross‑functional teams to ensure data integrity, create sophisticated reporting, and support initiatives that enhance performance and operational efficiency.
Responsibilities include but are not limited to the following:
 
Data Integrity &amp; Governance
<ul><li>Develop and maintain control structures to ensure data accuracy and quality across upstream and downstream systems.
</li><li>Conduct data integrity gap analyses and partner with business and IT teams to resolve discrepancies.
</li><li>Provide expertise on data flow processes, controls, and improvement opportunities.
</li></ul>Analytics &amp; Reporting
<ul><li>Prepare monthly and quarterly claims analytics reports for leadership.
</li><li>Analyze key performance indicators and support data‑driven decision‑making across the Claims organization.
</li><li>Perform ad hoc reporting and deep‑dive trend analysis using large, complex datasets.
</li><li>Assist with forecasting, strategic planning, and operational analytics.
</li></ul>Specialized Claims Insights
<ul><li>Support fraud detection, subrogation analysis, medical management reviews, and legal analytics.
</li><li>Manage and maintain various claims‑related databases.
</li><li>Investigate and resolve data irregularities, ensuring clarity and accuracy in all outputs.
</li></ul>Collaboration &amp; Communication
<ul><li>Partner with business stakeholders to understand requirements and develop tailored data solutions.
</li><li>Present findings in a clear, concise, and visually compelling format.
</li><li>Support technology evaluations and provide recommendations to senior team members.
</li></ul>Work Experience and Qualifications:
<ul><li>3-5 years of experience as a data analyst or experience in data mining (preferred).
</li><li>Insurance or reinsurance experience is helpful but not required.
</li><li>Strong understanding of databases, data structures, and data quality principles.
</li><li>Proficient in SQL, BI platforms, Python, and R. Intermediate proficiency in VBA.
</li><li>Skilled with Microsoft Office Suite (Word, Excel, Access, Project, Outlook).
</li><li>Excellent verbal and written communication skills.
</li><li>Strong analytical thinking, time management, and organizational abilities.
</li><li>Ability to work independently while managing multiple priorities.
</li><li>Experience documenting functional requirements and working with cross‑functional teams.
</li><li>Bachelor&rsquo;s degree in a related field preferred.
</li></ul>The base salary range for this position is $100,000 - $130,000 annually. The offered rate of compensation will be based on individual education, experience, qualifications and work location. All offers include access to a variety of benefits to employees, including health insurance coverage, an employee wellness program, life and disability insurance, 401k match, retirement savings plan, paid holidays and paid time off (PTO).
#LI-KG1
#LI-Hybrid
What if I don&rsquo;t meet every requirement? At Everest we are dedicated to building an inclusive and authentic workplace. So, if you are excited about this role but your past experience doesn&rsquo;t align perfectly with every element in the job description, we still encourage you to apply. You may be just the right candidate for this or other roles. Please let us know if you need any accommodations throughout the application or interview process. 
Our Culture
At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors.
<ul><li>Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Inclusion and Belonging.
</li><li>Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together. 
</li></ul>All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve.
Type:
Regular
Time Type:
Full time
Primary Location:
Warren, NJ
Additional Locations:
Philadelphia, PA
Everest is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy), sexual orientation, gender identity or expression, national origin or ancestry, citizenship, genetics, physical or mental disability, age, marital status, civil union status, family or parental status, veteran status, or any other characteristic protected by law. As part of this commitment, Everest will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Everest Benefits at everestbenefits@everestglobal.com.
Everest U.S. Privacy Notice | Everest (everestglobal.com)</div>

Insurance Claims Data Research Analyst

UMB Bank

<div>
 Our
 
 Enterprise Fraud Claims
 
 team is responsible for formally investigating all unauthorized transactions focusing on protecting customer assets, secure compromised accounts, and recover stolen funds.
 
 
 As the
 
 Fraud Claims Analyst
 
 , your focus is toward investigating fraudulent confirmations against customers and the UMB organization. You will take on fraud claims for all payment channels that our customers utilize throughout the organization. You are the determining factors in making vital decisions for determining how fraud is happening, where it is happening, and how they can put a stop to it. You will work closely within their team environment to support one another and to be successful. While working across multiple departments, you will help customers and UMB get millions of dollars in loss back. This is a subset of the overall responsibilities which will include multiple initiatives as assigned by Bank Operations leadership.
 
 
 
 This role is hybrid (Mon through Thu on-site / Fri remote; 900 &ndash; 500 PM) at the UMB Technology &amp; Operations Center located in downtown Kansas City, MO.
 
 
 
 
 How You&rsquo;ll Spend Your Time
 
 
 
 <ul>
 <li>
 Manage multi-channel fraud claims.
 </li>
 <li>
 Continually evaluate the effectiveness of existing case management tools and identify to the Manager, Fraud Claims of performance gaps or defects.
 </li>
 <li>
 Adhere to the applicable regulatory requirements governing fraud claims for checks, ACH, and wire.
 </li>
 <li>
 Ensure compliance with Bank standards, policies, and procedures.
 </li>
 <li>
 Work closely with the Enterprise Fraud Data Strategy team to produce appropriate data and reporting to fulfill overall business needs and expectations.
 </li>
 <li>
 Work closely with the Fraud Prevention Team and Line of Business (LOB) partners to identify adverse impacts to customers, provide solutions, and implement changes to ensure the best customer experience.
 </li>
 <li>
 Communicate regularly with peer banks and industry organizations to maintain awareness of industry risks and trends.
 </li>
 <li>
 Stay current with UMB&rsquo;s fraud policies and procedures.
 
 
 </li>
 </ul>
 
 
 We&rsquo;re excited to talk if you have
 
 
 
 
 <ul>
 <li>
 At least 2 years of fraud claim processing or fraud operations experience in check, ACH or wire.
 </li>
 <li>
 Knowledge of NACHA rules and the Uniform Commercial Code as they apply to case management and recovery actions.
 </li>
 <li>
 Strong problem-solving skills to investigate fraudulent claims against our customers and the UMB organization.
 </li>
 <li>
 Excellent communication skills to provide updated information to parties to ensure all information is communicated for adequate research for fraud.
 </li>
 <li>
 Team-focused approach to work out solutions within your team to help conduct plans and research to stop and defeat fraud.
 </li>
 <li>
 Experience with Microsoft 365 applications.
 
 
 </li>
 </ul>
 
 
 Bonus Points if you have
 
 
 
 
 <ul>
 <li>
 Cross payment multi-channel fraud experience.
 </li>
 <li>
 Experience with Oasis, Hogan, NICE Actimize, or FIS Systems.
 
 
 </li>
 </ul>
 
 Applicants must have legal authority to work in the United States. Work Visa sponsorship is not available for this position.
 
 
 
 
 Compensation Range
 
 
 
 $44,790.00 - $86,510.00
 
 
 
 The posted compensation range on this listing represents UMB&rsquo;s standard for this role, but the actual compensation may vary by geographic location, experience level, and other job-related factors. In addition, this range does not encompass the full earning potential for this role. Please see the description of benefits included with this job posting for additional information
 
 
 
 UMB offers competitive and varied benefits to eligible associates, such as Paid Time Off; a 401(k) matching program; annual incentive pay; paid holidays; a comprehensive company sponsored benefit plan including medical, dental, vision, and other insurance coverage; health savings, flexible spending, and dependent care accounts; adoption assistance; an employee assistance program; fitness reimbursement; tuition reimbursement; an associate wellbeing program; an associate emergency fund; and various associate banking benefits. Benefit offerings and eligibility requirements vary.
 
 
 
 Are you ready to be part of something more?
 
 
 
 You're more than a means to an end&mdash;a way to help us meet the bottom line. UMB isn't comprised of workers, but of people who care about their work, one another, and their community. Expect more than the status quo. At UMB, you can expect more heart. You'll be valued for exactly who you are and encouraged to support causes you care about. Expect more trust. We want you to do the right thing, no matter what. And, expect more opportunities. UMBers are known for having multiple careers here and having their voices heard.
 
 
 
 UMB and its affiliates are committed to inclusion and diversity and provide employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex (including gender, pregnancy, sexual orientation, and gender identity), national origin, age, disability, military service, veteran status, genetic information, or any other status protected by applicable federal, state, or local law. If you need accommodation for any part of the employment process because of a disability, please send an e-mail to talentacquisition@umb.com to let us know the nature of your request.
 
 
 
 
 If you are a California resident, please visit our
 
 Privacy Notice for California Job Candidates
 
 to understand how we collect and use your personal information when you apply for employment with UMB.
 
</div>

Fraud Claims Analyst

Dubai Insurance TPA

1. JOB PURPOSEThe Utilization Management Analyst is responsible for supporting the utilization management team through the analysis and reporting of KPIs, identifying key utilization drivers, and contributing to large policy management initiatives. This role requires a data-driven approach to analyze claims, track performance metrics, and collaborate on the development of insights that promote effective utilization of healthcare resources.2. RESPONSIBILITIES AND DUTIESKPI Tracking and Reporting:Assist in the collection, organization, and analysis of utilization management KPIs for reporting to senior leadership and payers.Generate regular reports and dashboards in collaboration with the Data Analytics team.Utilization Analysis:Conduct analyses of concurrent and retrospective claims to identify primary utilization drivers by provider, physician, and service.Contribute insights into utilization trends and cost drivers using data visualization tools.Segment and Payer-Level Data Review:Perform data reviews on utilization patterns across business segments and payers to support targeted performance improvements.Provide input on payer-specific utilization trends to aid in developing remediation plans.Large Policy Support:Contribute to large policy utilization management by analyzing data on outlier claims and high-risk members.Assist in identifying potential interventions or consultations needed with payers.Job Types: Full-time, PermanentPay: AED9,000.00 - AED12,000.00 per monthWork Location: In person

Utilization Management Analyst - Insurance TPA

Community Bridges, Inc.

Community Bridges, Inc. (CBI) is an integrated behavioral healthcare agency offering a variety of different programs throughout Arizona. CBI provides residential, outpatient, inpatient, patient-centered medical homes, medication-assisted treatment, and crisis services to individuals experiencing crisis, opioid use disorder, homelessness, and mental illness.
 
Medical Billing Analyst
 Community Bridges, Inc. (CB I) is an integrated behavioral healthcare agency offering a variety of different programs throughout Arizona. CBI provides residential, outpatient, inpatient, physical health, medication-assisted treatment, and crisis services to individuals experiencing, substance use disorder, homelessness, and mental illness.
 
CBI is the premiere non-profit fully integrated healthcare provider of substance use and behavioral health programs in Arizona, including prevention, education and treatment using cutting-edge, nationally recognized, evidence-based models.
 
Job Summary
 
The Medical Billing Analyst will be responsible for the qualification, data analysis, data accuracy, preparing and submitting claims to payers. This position is responsible for timely and compliant claim submissions in accordance to the billing requirements set forth by the payers. This position is also responsible for monitoring and analyzing the quality of data reported in billing records to ensure that they are submitted in accordance to standards, policies and procedures and will initiate necessary corrections to ensure the quality of the information billed.
 The ideal candidate will be a self-starter with strong attention to detail and an ability to work in a fast-paced environment.
 
Skills/Requirements
 
<ul>
<li>High School diploma or GED required. Associate Degree or higher preferred.</li>
<li>Minimum 18 months experience with billing medical claims</li>
<li>Minimum 18+ months experience performing healthcare reimbursement,</li>
</ul>
behavioral health insurance/billing or related work.
 <ul>
<li>Knowledge of CPT, HCPCS and Modifier experience required.</li>
<li>Experience with behavioral health claims preferred.</li>
<li>Experience working in a remote environment preferred.</li>
<li>Valid identification required.</li>
<li>Billing certificate preferred.</li>
</ul>
CBI Offers an excellent benefits package!
 
<ul>
<li>Generous PTO accrual (5 weeks!),</li>
<li>Medical, Dental, Vision, Disability, Life, Supplemental plans</li>
<li>Hospital indemnity/ Critical Illness,</li>
<li>Pet Insurance,</li>
<li>Dependent Care Savings, Health Care Savings,</li>
<li>401K with employer match - 100% vested upon enrollment,</li>
<li>Wellness programs,</li>
<li>Tuition Reimbursement and Scholarship Programs, incentives, and more!</li>
<li>Very Competitive pay rates</li>
</ul>
CBI is growing and expanding our services!
 
<ul>
<li>We are experiencing tremendous growth in this time. As an essential service provider, we value all our employees and their careers.</li>
<li>*For the past four years, The Phoenix Business Journal has recognized CBI as one of the top ten healthiest mid-size employers in the Valley! *</li>
</ul>
CBI Values your Career and have lots of growth opportunities!
 
Our staff experience tremendous professional growth through ongoing training and support. Our team is supported by strong and competent leadership. The leadership at CBI is committed to ongoing professional development for their staff. Come join our team of passionate individuals who are serious about making a difference in the lives of our patients and the communities we serve.
 
About our Culture, commitment to employees!
 
<ul>
<li>We are looking for driven and compassionate individuals that thrive in an upbeat and safe working environment. We dedicate a lot of thought and effort into work life balance as well as our competitive composition structure.</li>
<li>We know life happens, that’s why we all start with a 5-week PTO plan as well as a wide range of unique benefits!</li>
</ul>
Our Facilities.
 
Our 26 locations are all state-of-the-art facilities that provides top notch integrated care. We are proud to adhere to a “no wrong door” treatment approach that allows our staff to dramatically improve the quality of life for the patients in their care.
 
CBI treats patients from all different walks of life and believes in maintaining the dignity of human life. Recovery is possible!
 
CBI Offers an excellent benefits package!
 <ul>
<li>Medical, Dental, Vision, Disability, Life, Supplemental plans - Hospital indemnity/ Critical Illness, Pet Insurance, Dependent Care Savings, Health Care Savings, 401K with employer match - 100% vested upon enrollment, Generous PTO accrual, Wellness programs, Tuition Reimbursement and Scholarship Programs, incentives, and more!</li>
<li>For the past four years, The Phoenix Business Journal has recognized CBI as one of the top ten healthiest mid-size employers in the Valley.</li>
</ul>
CBI treats patients from all different walks of life and believes in maintaining the dignity of human life. Recovery is possible!

CCBO - Medical Billing Analyst

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