Top 34 Claims associate remote Jobs in Providence, Ri

Lead Provider Payment Integrity Analyst
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $92,700 - $139,100 a year
- Full-time
- Remote
- 7 years
- Mid-level
- Office
- Loan repayment program
- Dental insurance
Investigator
UnitedHealthcare —Warwick, RI
- $49,700 - $88,800 a year
- Full-time
- Hybrid work
- Microsoft Word
- Up to 50% travel
- Pass drug screening
2d
Attorney
Litchfield Cavo LLP —Providence, RI
- $105,000 - $130,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Analysis skills
- Health savings account
- Health insurance
Quick Apply
Attorney (Workers' Compensation)
Litchfield Cavo LLP —Providence, RI
- $105,000 - $130,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Case Mgr - DSNP
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $73,600 - $110,400 a year
- Full-time
- Hybrid work
- Bilingual
- RN License
- Mid-level
- Loan repayment program
- Dental insurance
Case Manager - Behavioral Health
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $73,600 - $110,400 a year
- Full-time
- Hybrid work
- Hospital
- Mid-level
- Office
- Loan repayment program
- Dental insurance
Senior Data Visualization Analyst
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $93,600 - $140,400 a year
- Full-time
- Hybrid work
- Computer science
- Azure
- Computer Science
- Loan repayment program
- Dental insurance
Director Payment Integrity
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $116,900 - $187,100 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Excel
- 5 years
- Loan repayment program
- Dental insurance
8d
Senior Investigator - Rhode Island
UnitedHealthcare —Warwick, RI
- $60,200 - $107,400 a year
- Full-time
- Hybrid work
- Microsoft Word
- Up to 50% travel
- Pass drug screening
2d
Lead Total Cost of Care Implementation Manager
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $102,300 - $163,700 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Mid-level
- Office
- Loan repayment program
- Dental insurance
DSNP RN Care Manager
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $73,600 - $110,400 a year
- Full-time
- Hybrid work
- LMFT
- RN License
- Licensed Clinical Social Worker
- Loan repayment program
- Dental insurance
Senior Medical Economics Analyst
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $93,600 - $140,400 a year
- Full-time
- Hybrid work
- Office
- Master's degree
- SQL
- Loan repayment program
- Health insurance
Claims Investigator - Part Time
Command Investigations, LLC —Providence, RI
- $23 - $30 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
Fresh Buyer II
UNFI —Providence, RI
- $56,400 - $102,400 a year
- Full-time
- Marketing
- Word processing
- Merchandising
- Health savings account
- AD&D insurance
Quick Apply
4d
Account Manager Associate - Commercial Lines
Insurance Office of America, Inc. —Providence, RI
- $55,000 - $65,000 a year
- Full-time
- 7 years
- Microsoft Outlook
- Word processing
- Paid holidays
- Health insurance
Quick Apply
Resident Services Manager 2 - Lodge at Foxborough
Western Residential Inc. —Foxborough, MA
- $33.65 - $36.06 an hour
- Inventory management
- Mid-level
- Office
Quick Apply
Senior Administrative Coordinator
RTX Corporate —Middletown, RI
- $53,100 - $100,900 a year
- Full-time
- 6 years
- High school
- Mid-level
- Paid parental leave
- Paid holidays
1d
Registered Nurse (Patient Aligned Care Team)
US Veterans Health Administration —Providence, RI
- $88,157 - $159,579 a year
- Part-time
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Loan repayment program
1d
Logistics Coordinator – Transportation Operations & Freight
D2G Group LLC —Fall River, MA
- From $25 an hour
- Full-time
- Hybrid work
- Microsoft Outlook
- Mid-level
- Office
Quick Apply
12d
Advanced Practice Nurse (Primary Care)
US Veterans Health Administration —Providence, RI
- $127,820 - $193,796 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Loan repayment program
3d

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claims associate remote jobs near providence, ri

Lead Provider Payment Integrity Analyst

Blue Cross and Blue Shield of RI Careers -
Providence, RI

Apply Now

Job Details

Full-time
$92,700 - $139,100 a year

Benefits

Loan repayment program
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance

Qualifications

Contract documentation review
Contract review
National Correct Coding Initiative (NCCI) guidelines
SAS
Spreadsheets
Regulatory compliance in claims processing
Contract interpretation
State healthcare regulations
Quality control audit
Risk analysis
Insurance claims auditing
Business requirements
Query management
Healthcare claims compliance audits
Financial data analysis tools
Medical terminology
Audit support
Statistical analysis tools
Financial compliance

Full Job Description

Pay Range:

$92,700.00 - $139,100.00

Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.
It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We’re dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Why this job matters:

Conduct complex, in-depth analysis of claim payments and its methodology, identifying trends and patterns, to ascertain cost avoidance/overpayment recovery opportunities. Apply root cause analysis to design and develop solutions to payment integrity opportunities/issues, and coordinate implementation efforts with internal stakeholders as well as vendor(s) and providers as applicable. Ensure medical claims, records, and other documentation essential to claims submission and reimbursement is in compliance with state and federal guidelines, provider contracts, BCBSRI policy, national coding guidelines and industry standards. Detect areas of billing inefficiencies, internal control weaknesses, and noncompliance and provide recommendations for corrective action plans.

What you will do:

Conduct a thorough analysis of all medical claims for adherence to state and federal guidelines, provider contracts, BCBSRI policy, national coding guidelines and industry standards.
Create new recurring and ad-hoc reports to identify cost avoidance/overpayment opportunities using large data sets on multiple variables. Provide data, analysis and recommendations to management on all findings affecting payments; including policy, contract issues, provider errors, pricing, systems and claim processes.
Work with internal stakeholders to make any necessary technical updates to the system, policies and procedures when necessary as well as coordination of education to providers. Track and report progress of prospective and retrospective cost avoidance/overpayment recoveries.
Carry out new recovery concepts within the established deadlines with a high level of accuracy. Resolve any challenges made to the proposed cost avoidance/overpayment concepts throughout the organization, including but not limited to Provider Relations, Provider Contracting, Medical/Payment Policy and Legal.
Build strong stakeholder relationships and deliver solutions that meet stakeholders’ expectations; establish and maintain effective relationships – both internal as well as external.
Develop written reports in accordance with reporting standards. Ensure that all audit findings, exceptions and proposed adjustments to work papers/communication documents are well defined and explained or included in reports.
Perform other duties as assigned.

What you need to succeed:

Bachelor’s degree in Business, Healthcare, Finance, Mathematics, Statistics or related field; or an equivalent combination of education and experience
Seven or more years of experience in medical claims review or claims processing
Seven or more years of experience in quantitative or statistical analysis (preferably in health care)
Experience using PC SAS (preferably Enterprise Guide SAS), Crystal, SQL, and/or Business Objects.
Proven analytic expertise using Microsoft Excel and Access, database query capabilities, and ability to evaluate data at all levels of detail
Experience with manipulating large datasets
Experience with medical terminology, claim audit procedures, provider contracts, claims processing procedures and guidelines.
Knowledge of medical claims data
Knowledge of Correct Coding Initiative (CCI) guidelines
Audit skills and the ability to interpret and apply Federal and State regulations, coding and billing requirements.
Demonstrated ability to review analytical, data and audit findings to identify coding trends and risk areas.
Ability to interpret contract reimbursement schedules and policies
Strong organizing skills, with the ability to prioritize and respond to shifting deadlines
Ability to manage diverse and deadline-oriented workflow
Strong analytical, conceptual, and problem-solving skills to evaluate complex business requirements

The extras:

Knowledge of diagnostic related groups (DRG’s) and American Hospital Association Official Coding Guidelines
Knowledge of Current Procedural Terminology (AAPC Certification preferred)
Familiarity and ability to interpret hospital/provider contracts
Familiarity with medical claims reimbursement
Financial/Accounting methodology exposure
Experience with lean or six sigma

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

In-office : onsite 5 days per week
Hybrid: onsite 2-4 days per week
Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.

Apply Now

Refine Your Search

claims associate remote jobs in providence, ri

Lead Provider Payment Integrity Analyst

Investigator

Attorney

Attorney (Workers' Compensation)

Case Mgr - DSNP

Case Manager - Behavioral Health

Senior Data Visualization Analyst

Director Payment Integrity

Senior Investigator - Rhode Island

Lead Total Cost of Care Implementation Manager

DSNP RN Care Manager

Senior Medical Economics Analyst

Claims Investigator - Part Time

Fresh Buyer II

Account Manager Associate - Commercial Lines

Resident Services Manager 2 - Lodge at Foxborough

Senior Administrative Coordinator

Registered Nurse (Patient Aligned Care Team)

Logistics Coordinator – Transportation Operations & Freight

Advanced Practice Nurse (Primary Care)

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