Emblemhealth jobs - Parsippany, NJ

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Feb 08 Sr. Technical Analyst Emblemhealth New York, NY

Designs and develops computer application solutions to support complex business processes to support Provider Network and Data Management systems. Establishes standards and... more

Mar 28 Hospital Review Analyst Emblemhealth New York, NY

Summary: Reviews coding data on institutional (hospital) and professional (medical) claims and clinical information on medical records to ensure compliance with American Hospital... more

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Mar 24 Sr. Actuarial Analyst Emblemhealth New York, NY

Summary: Provides support in the Actuarial Department for reporting, rate filing, fee schedule analysis, and other actuarial support as needed. Accountabilities: • Collects... more

Mar 25 Dir., Testing Emblemhealth New York, NY

Summary: Oversees the planning, assists with definition of requirements, testing, implementation, management and improvements of all QCARE applications to process professional and... more

Apr 03 Grievance & Appeal Specialist Emblemhealth New York, NY

Responds to written/verbal grievances, complaints, appeals and disputes submitted by members and providers in accordance with NCQA, CMS, NY State and other regulations. Types of... more

Apr 03 Credentialing Specialist Emblemhealth New York, NY

Conduct activities related to initial credentialing, recredentialing, delegation, facility credentialing and ongoing provider file maintenance. Conduct all processes to remain... more

Apr 07 Lead Business Data Analyst Emblemhealth New York, NY

Execute a variety of complex analytical exercises to provide operations and medical management with actionable, high quality quantitative information that drives effective... more

Apr 07 Dir.,Payment Reconciliation Emblemhealth New York, NY

process of payment reconciliation for all EmblemHealth medical and hospital claims across all legacy platforms. • Develop system and process workflows and controls to address all... more

Apr 07 Sr. Rates Specialist Emblemhealth New York, NY

Summary: Ensure that all facility contracts received are logged, reviewed and loaded accurately in the contracting system (Qcare). Respond accurately and timely to contract... more

Apr 10 Lead Operations Reporting Analyst Emblemhealth New York, NY

Summary of Position The Lead Operations Reporting Analyst for Special Populations will develop, manage, and monitor a variety of complex analytical and reporting capabilities... more

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