Medical Claim Analyst

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Waste & Error Certified Coding Manager is responsible for leading the Certified Coding Analyst and W&E Team Lead roles that conduct medical claim reviews and coding audits to identify billing errors, waste, abuse, fraud, and payment integrity opportunities. The Manager provides direct people leadership, establishes operational priorities, ensures consistent application of coding and billing requirements, and is accountable for team productivity, quality, service levels, compliance, and employee development. This role partners closely with the W&E team lead, who provides day-to-day technical guidance and subject matter support to the coding team. The Manager retains accountability for staffing, performance management, workload oversight, escalations, audit readiness, process improvement, and delivery of business outcomes. The position also represents the team in discussions with senior leadership, Medical Directors, Legal, Compliance, Analytics, Operations, and other Payment Integrity partners. Primary Responsibilities People Leadership & Team Development Lead, coach, and develop a team of Certified Coding Analysts and Senior Certified Coding Analysts. Establish clear role expectations, performance goals, productivity standards, quality requirements, and accountability measures. Conduct regular perfor

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The growing DSNP business has created an opportunity for an individual with claims experience, who is familiar with the 837 standard claims format. This individual will own 837 file transmissions to the states, manage and act on state response files, ensuring that all transactions transmitted are complete and error free. Manage and complete error corrections to meet state requirements. Required Qualifications 1&#43; year of experience with encounter data, medical claims, or Medicare/Medicaid. 1&#43; year of experience using FTP and data transfer software. 1&#43; year of data management experience. Preferred Qualifications Experience with Microsoft Access Databases. Analytical skills with the ability to identify and resolve data discrepancies. Working knowledge of the 837 claims files. Education Bachelors degree or equivalent work experience Anticipated Weekly Hours 40 Time Type Full time Pay Range <p s

JOB DESCRIPTION: Abbott is a global healthcare leader, creating breakthrough science to improve people’s health. We’re always looking towards the future, anticipating changes in medical science and technology. Our rapid diagnostics solutions are helping address some of the world’s greatest healthcare challenges. The Opportunity As the Finance Manager, SEA, you will be responsible for consolidating and reporting sales, P&L, and balance sheet results (actuals and forecasts) across Southeast Asia. You will partner closely with business leaders, support day-to-day finance operations, provide financial reporting and analysis, and ensure compliance with corporate financial policies and procedures. What You’ll Do Consolidate/Report for Sales and P&L and Balance Sheet (actual and forecast) for ID SEA: (Singapore, Malaysia, Vietnam, Thailand, Philippines, Indonesia, Cambodia, Laos, Vietnam) for Actual, RLBE/Forecast and Confirmation. Working closely with CM/GM as a strong Finance business partners and supports day to day business operations issues. Ensure completion of month end/year end closing with SSO / CFS team. Work along closely with SSO / CFS team on actual reporting, credit control, payment and all operations matters. Consolidate/Report/Monitor Cash Conversion Cycle, and Credit Management for SEA markets Distributors management: renewal/appointment process, inventory management, credit/margin claims processes, etc. Reporting and tracking of end-customer sales: (primary, secondary, inventory) across SEA markets Financial Analysis / Decision Support – Consolidate to understand the key drivers of profitability issues relating to any given Plan or RLBE cycl

Opportunity Overview: As Quality Specialist will implement quality measurements, scoring, and performance improvement data designed to improve operational efficiency while exceeding industry standards for quality performance. You will apply subject-matter expertise to guide and support the training and quality needs of Intake Operations. This includes building the success of the company through training and development. With a solid foundation in quality analysis, feedback, instructing/coaching; you are expected to be flexible and nimble in your role to manage short- and long-term projects as well as dealing with day-to-day QA tasks. Cohere culture is one of partnership and ownership. What you’ll do: Translate QA findings into clear insights and recommendations for operational leaders and cross-functional partners. Develop and deploy structured coaching sessions based on audit findings to improve accuracy, decision-making, and skill development. Create and ensure accuracy of SOPs, job aids, workflow guides, and new product readiness materials. Facilitate onboarding and ongoing upskilling sessions using adult learning principles and SME feedback. Lead QA/Training side of project implementations by operationalizing workflow changes, quality expectations, and training updates into the business. Partner with Product, Clinical, Client Services, and Operations to validate workflow changes and identify potential quality or compliance risks. Support change management by communicating process updates and aligning QA expectations across impacted teams. Serve as a subject matter expert and advisor to frontline leaders on quality trends, training needs, and operational readiness. Manage multiple concurrent priorities with independence, ownership, and accountability for deliverables, exercise discretion and independent judgment. Step into operational queues to maintain service levels and ensure continuity of operations, as needed during high-volume periods. Other duties as assig

Opportunity Overview: The Intake Specialist role is a key position supporting US healthcare operations by ensuring accurate and timely processing of patient and provider requests. In this role, you will support healthcare providers, internal clinical teams, and operations teams by collecting, reviewing, and processing information required for healthcare services and prior authorization workflows. As an Intake Specialist, you will manage healthcare requests received through multiple channels including phone, email, fax, and online platforms. You will be responsible for gathering required documentation, validating information, updating systems accurately, and ensuring requests are processed within defined turnaround times. This role requires strong communication skills, attention to detail, problem-solving ability, and the ability to work effectively in a fast-paced healthcare operations environment. What you’ll do: Provider/Customer Calling Support (Inbound & Outbound) Handle inbound and outbound calls with US healthcare providers and stakeholders. Process incoming healthcare requests received from US providers through Calls , fax, email, and electronic systems. Review medical documentation for completeness and accuracy. Validate required information needed for prior authorization and clinical review. Enter and update patient, provider, and request details accurately in healthcare systems. Identify missing information and coordinate with appropriate teams/providers for resolution. Maintain high standards of accuracy, quality, and productivity. Follow HIPAA guidelines and maintain confidentiality of patient information. Support process improvements and operational initiatives. Provide professional and timely support while addressing provider questions and requests. Document all interactions accurately in internal systems. Provide first-level resolution whenever possible. Escalate complex issues to appropriate teams. Maintain a customer-focused approach during ever

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience. Additional Responsibilities - Reviews pre‑specified claims and those that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication. - Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures. - Identifies and reports potential overpayments, underpayments, and other claim irregularities. - Performs claim rework calculations as needed. - Trains and mentors as needed to enhance team performance and technical proficiency. - Conducts outbound calls to obtain required information for claims or reconsideration requests. Required Qualifications - Minimum of 18 months of medical claim processing experience with a health insurance payor or third‑party administrator. - Proven