69 jobs found in miami

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Facilitate end to end management of external and internal client audits of pharmacy benefits and pricing Gather PBM plan documentation from internal teams to provide to external audit firm  Read and interpret plan design documents and PBM service agreements...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)   Join the Claims team as a Software Engineer focusing on Backend. The team is responsible for developing, maintaining, enhancing and setting a high-quality bar for web and mobile apps which assists end users in taking control of their healthcare claims and benefits. The team has a strong and integrated relationship with the product team based on strong collaboration, trust and partnership.  Goals for the team are focused on creating meaningful positive impact for our customers through clear and measurable metrics analysis. As a...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) The role is key to speed to value development based on human centered design principles before promoting reports to a product licensed version. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Responsible for custom development for new client implementations, client data migrations, as well as support of Pre-Sales data acquisition for analysis in support of Sales operations Support the Optum Insight Payer Analytic solutions...

Gallagher is a global leader in insurance, risk management and consulting services. We help businesses grow, communities thrive and people prosper. We live in a culture defined by The Gallagher Way, our set of shared values and guiding tenets. A culture driven by our people, over 30,000 strong, serving our clients with customized solutions that will protect them and fuel their futures. Position Summary: We are looking for a dynamic and proactive individual to join our team providing business support to our Management Team, Producers and Brokers in servicing our clients. Important that the candidate is strong in data analytics. Key Responsibilities: Working closely with the management team you will provide business support for a range of business areas, this will in particular include the need to conduct analysis work to a consistent high standard: Using data mining to extract information from data sets and identify correlations and patterns Organizing and...

Gallagher is a global leader in insurance, risk management and consulting services. We help businesses grow, communities thrive and people prosper. We live a culture defined by The Gallagher Way, our set of shared values and guiding tenets. A culture driven by our people, over 30,000 strong, serving our clients with customized solutions that will protect them and fuel their futures. Position Summary: The Branch Client Service Associate is accountable for delivering high quality and efficient service to both internal and external clients by assisting with the Branch's overall workflow processes and providing routine client support. This role reports directly into either the Branch Client Service Management Manager or the Branch Client Service Supervisor. The Branch Client Service Associate contributes to key business outcomes such as client retention, client satisfaction, enhancing AJG's value to our clients and prospects, achieving operating/margin targets and fostering a...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)  The Facets Provider Pricing Capitation Analyst will be responsible for reading, interpreting, and building contracts for contracted providers who are reimbursed according to a capitation method. They will also be accountable for reviewing the work of others and providing feedback to remediate configuration anomalies identified. Capitation analyst will execute programs to evaluate preliminary month-end reporting statistics and make any adjustments required to properly administer contractual requirements. You’ll enjoy the flexibility to...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) You’ll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges. Primary Responsibilities: Review, interpret and/or verify contract language, information, and intent in order to load information into systems properly Ensure contract templates can be administered across operations (pricing config, claims, etc.) Communicate identified discrepancies to Network Management, Contracting and Pricing Requirement teams Reviews company specific, CMS specific, State Specific and competitor specific medical policies and reimbursement policies Translates medical policies into...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing y our life's best work.(sm) Project management and oversight of complex clinical programs under the guidance of the Clinical Program Director and Designer and in collaboration with internal and external teams. This role will require a methodical and critical thinking mindset with the ability to handle multiple priorities as well as the ability to drive implementation of initiatives and monitor existing programs with the support from Enterprise executive leaders to operational support teams. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.  Primary Responsibilities: Initiative Implementation...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) This is a leadership position that's all about leveraging your experience, skills, and potential towards solving bigger opportunities with enterprise and industry impacts.  In this role, you will not only lead core data operations teams, but also drive innovation through strategic collaboration that improves the experiences of our employees, providers, and members.  We're achieving higher levels of service and quality in how provider data is managed and performs in our systems - join us and you'll play a key role in helping healthcare professionals focus on taking care of patients instead of data administration. This role will put you on a...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) If you are located in Ontario, you will have the flexibility to telecommute* as you take on some tough challenges. Will work onsite and there will be some telecommuting. Must be local candidate. Primary Responsibilities: Identify and resolve new or unusual EDI claims errors/issues as they arise, using established procedures  Achieve applicable performance metrics (e.g., productivity, quality, TAT) Use...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) As a Data Engineer , you will be working with Electronic Medical Records, Billing, and other data types that we receive from our health care provider clients. Where these data are part of our cadre of known data sources, you will be responsible for evaluation of those sources against the existing standard.  Where they are not, you will have the added pleasure of creating the new standard which will be applied. In...

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing  your life's best work.SM As member of the C&S UAT/Test Team, the Claims Business Process Technician will develop enhanced automation test opportunities and create & maintain test suites utilizing test automation applications.  You will work closely with our test team, technology & business partners to flawlessly deliver on test plans, & quality expectations, as it relates to the Claims End to End process on CSP Facets & surrounding systems.  This role should have a strong understanding of claims end to end system functionality as well as the up and down stream applications. These roles include, but...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do  your life's best work.(sm) What's most important to you in building your career and your future? Impact? Purpose? Potential? In that case, you're in the right place. UnitedHealth Group is a Fortune 5 leader in health care and an innovative driver of change in how the health system performs. As we continue to build and manage provider networks to serve our patients and families, we need to be sure that we're covering all aspects of the...

About the Role: As the Finance Director for Optum Ireland you will be responsible for driving the financial strategy for Ireland Operations. Our Finance Directors generate forecasts, and analyze trends in sales, SG&A, premium yields and other areas of business. In addition, you will research economic progressions to assist with the organization's financial planning and partner with upper management when presenting consequent recommendations. There will also be responsibilities such as team management, budget planning and analysis Responsibilities: Works closely with the business to develop, recommend and establish strategies, plans, and processes to improve profitability and cost efficiencies Works closely with Group Accounting Policy and Corporate tax to drive  financial strategy and execution for the unit. Knows where to obtain all relevant data and uses financial reporting software to efficiently meet the reporting needs of management Understands...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)   The Optum Care Provider Data Process and Support Subject-Matter-Expert (SME) is responsible for varying support functions for our Provider Data Management (PDM) team.  Primary duties are centered around fielding process-related questions, researching claim or provider set-up issues, performing root-cause analysis, as well as recommending and implementing remediation steps for issue prevention and/or reduction.  This...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing  your life's best work.(sm) Responsible for the deployment and management of local data warehouses and various business intelligence systems for the Optum Care Pacific West region’s Care Delivery Organizations (CDO’s), inclusive of employed medical groups, affiliated provider networks, and risk bearing entities. Manages geographically dispersed professional staff (onshore/offshore) and subcontractor teams tasked with the design, implementation and deployment of analytics and reporting solutions. Collaborates with business & clinical operational teams to...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) Payment Integrity (PI) Products identify claims and claim patterns that indicate potential for overpayments, fraud, waste or abuse using advanced analytics and predictive models and support investigation and decisioning of the identified claims. This results in payment accuracy in healthcare claims, reduced healthcare costs and ultimately helps people live healthier lives This position is for Principal Engineer next generation Claim Audit Platform (CAP) for multiple Payment Integrity (PI) value streams in Azure leveraging...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) This position is responsible for the testing of system changes as it relates to claim processing, fee schedule updates, contract modifications, enrollment, premium billing, employer group, reconciliation and fulfillment within the Facets system. This position may be involved in day-to-day work as it relates to creating and executing test cases and on large scale initiatives. You’ll enjoy the flexibility to...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles less complex claims with moderate supervision and includes the investigation, determination and evaluation of coverage, liability and damages and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $5,000 liability and/or $10,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure to determine the proper course of action and to appropriately settle the claim. Interacts...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) Be part of this enterprise-wide claims transformation journey!!! The Strategic Claims Capability vision is to reimagine and simplify the end-to-end claim experience by providing a nimble and frictionless claim capability for all constituents, driving maximum affordability. The work will be challenging and rewarding!!! This is a transformational role and will require skill with managing change both internally and externally. This position works to collaborate, define and develop the claims strategy for the pre-processing product capabilities. This position will be pivotal in transforming the claims experience for our provider, member, and...