Employer Industry: Healthcare Services Why consider this job opportunity: - Opportunity for career advancement and growth within the organization - Competitive benefits and compensation package offered - Supportive and collaborative work environment - Chance to make a significant impact on payment integrity and claims operations - Involvement in meaningful work that aligns with regulatory compliance and healthcare standards What to Expect (Job Responsibilities): - Review Medicaid Coordination of Benefits (COB) claims for accurate secondary pricing logic and compliance with regulations - Analyze claim outcomes, identifying trends or discrepancies related to payments - Utilize QNXT for claims history research, provider contract setup, and benefits configuration - Collaborate cross-functionally with various teams to resolve identified issues - Act as a subject matter expert in Medicaid COB claim adjudication and provide training to junior analysts What is Required (Qualifications): - Associates Degree or equivalent combination of education and experience - 5+ years of experience in oversight, auditing, and government regulations/compliance - Strong understanding of QNXT claims processes and ability to troubleshoot discrepancies - Proficient in Microsoft Office applications, including Excel, Word, and PowerPoint - Effective written and verbal communication skills How to Stand Out (Preferred Qualifications): - Bachelor's Degree or equivalent experience - Prior experience in Payment Integrity and/or COB/Claims roles at a health plan or vendor - Familiarity with claim recovery audits and Medicaid regulatory reporting requirements - Exposure to EDI transactions (837, 835) and COB data exchange protocols - Experience with SQL #HealthcareServices #ClaimsOperations #PaymentIntegrity #CareerOpportunity #RegulatoryCompliance We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer. #J-18808-Ljbffr