Claims Analyst jobs in Glendale, Arizona (AZ)

Coordinates, prepares and performs actuarial analyses required to develop new products, project future results, reprice existing products, and/or determine financial strength.

Supervising appropriate personnel including analysts, less experienced associates, client personnel, clerical support, and others as appropriate.

Supporting detailed analyses of project schedule delays, cost overruns, productivity, contracts, change orders and other issues related to design and construction.

Analyzes new business plans and/or changes to existing business in order to establish the appropriate structure required for claims payment, reporting, innovation projects, etc.

Provide advanced analytical support for business operations in all or some of the following areas: claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting.

Provide advanced analytical support for business operations in all or some of the following areas: claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting.

Performs feasibility analysis, scopes project, and recommends alternative solutions, project strategy and deliverable prioritization.

The Government Health Plan/Managed Care Financial Consultant will project manage consulting work involving the review and analysis of Medicaid health plan reported performance.

Partners with other internal departments, including but not limited to Health Services, Medical Economics, Sales and Coding in order to develop solutions for strategic business needs.

Responsible for directing the review of current and future integration between the TriWest systems, to include TriWest medical management and web systems, which interface with the subcontractor's claims processing system. This position is also responsible for proactively and retroactively reviewing systems and claims for accuracy and efficiency. Leadership of and participation on multidisciplinary teams. Reviews and writes changes to promote error free claims processing.

Identifying and influencing cost reduction cash savings opportunities using financial analysis skills.

Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management.

Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management.

Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management.