Job Search Results for healthcare payer

REMOTE AI Product Manager

Insight Global is seeking to Lead AI Product Managers to join a global healthcare insurance provider client. One of the Product Managers will be providing support to a rapidly growing platform that... More enables members to understand and act on their healthcare benefits, claims, medications, and recommendations. The other role will focus on driving vision and evolution of products, with a focus on enhancing the right-hand search experience through relevant recommendations, third-party integrations, and deterministic AI-powered capabilities.The ideal candidate profile for both of these roles is someone who has demonstrated knowledge of technical AI and agentic concepts and has strong communication skills and experience working with technical stakeholders. These 2 opportunities are great for candidates looking to making an impact on the future of healthcare through the use of AI. . Compensation: $70 - 90/hr. Exact compensation may vary based on several factors, including skills, experience, and education.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Pre-Authorization Coordinator

Job DescriptionThe PAVE Coordinator is responsible for initiating Pre-Authorization request to the payer for the claims that require approval. This position require communication with payers,... More patients, physician offices and hospital clinical staff. This position is primarily responsible for pre-certifying procedures ordered by physicians. The PAVE Coordinator will also be responsible monitoring appropriateness and medical necessity and provides necessary information for authorization and continued visits. This individual will confirm pre-certifications that have been obtained or will obtain pre-certifications if needed in addition to conducting quality assurance.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Serve as primary resource for LH regarding insurance eligibility; prior authorization process and requirements; collects patient demographic information and coverage information. Advises patients of their financial obligation and collects payments in a courteous and professional manner.Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information;Updates systems with accurate information obtained; performs quality assurance audits and reports back to leadership opportunities for providing education to patient accessResponsible for communicating to service line partners of situations where rescheduling is necessary, due to lack of authorization or limited benefits and is approved by clinical personnel;Ensures that proper authorization is in place for inpatient, elective, outpatient, surgical, urgent/emergent services and held responsible for timely notification to payers of the patient?s visit to the facility to protect financial standing of the organization. Escalates non-authorized accounts/visits to management;Ensures all benefits (Copays, Deductibles, Co-Insurance, OOP, LTM), authorizations, pre-certifications, and financial obligations of patients, are documented on account, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts and denial prevention.;Maintains a close working relationship with clinical partners, and ancillary departments to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services, Surgical Scheduling departments. Case Management, and Utilization Review to facilitate the sending of clinical information in support of the authorization to the payer, as assigned;Monitors team mailbox, e-mail inbox, faxes, and phone calls responding to all related PAVE account issues, within defined time frames; Adheres to the department accuracy and performance standards.Contact payer to obtain prior authorization. Gather additional clinical and or coding information, as necessary, in order to obtain prior authorization;We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Denial Coordinator

Insight Global is looking for a Denial Coordinator to support a large hospital system in the Maryland/DC area. This person will support the Denials Appeals and Performance team, a centralized... More hospital denial team serving 10 hospitals. This role is hospital-based and denial-type driven, with work assigned via CARC codes rather than by inpatient or outpatient setting. Denials primarily include no-authorization (technical) and medical necessity / level-of-care (clinical) denials. Denial Coordinators work closely with RN reviewers and fellow technical staff in a fast-paced, collaborative environment.This is a production-focused role, with an expected daily volume of approximately 40 appeals per day, varying in complexity. Primary Responsibilities:- Work hospital denial accounts routed through proprietary system based on denial reason- Review denial letters to determine appeal feasibility and next steps- Draft and submit clear, detailed appeal letters for: ? No-authorization denials (technical)? Medical necessity and level-of-care denials (in partnership with RNs)- Collaborate daily with: ? RN reviewers? Other denial coordinators? Leadership and managed care partners as needed- Maintain timely follow-up on appealed accounts to ensure resolution- Identify denial trends and escalate issues appropriately- Participate in: ? Daily huddles? Case review meetings? Interdisciplinary denial discussions- Support special projects related to denial trends, payer behavior, or backlog reduction- Adapt to evolving workflows as the DAP team continues to build and scaleWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

REMOTE AI Product Manager

Insight Global is seeking a AI Product Manager to join a global healthcare insurance provider client. This candidate will be responsible for providing product management support for the build out of... More AI agents to support customs claims, benefits accumulators and the customer service ID card space. The ideal candidate profile is someone who has demonstrated knowledge of technical AI and agentic concepts and has strong communication skills and experience working with technical stakeholders. This is a contract to start with the potential to convert for the right candidate. Compensation: $70 - 90/hr. Exact compensation may vary based on several factors, including skills, experience, and education.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

AR Specialist

DAY TO DAY:The Accounts Receivable Specialist follow up with insurance carriers on denied, underpaid, or unresolved insurance claims. This position requires a comprehensive understanding of the... More entire revenue cycle and appropriate actions to take to resolving claim issues with payers in a timely manner.RESPONSIBILITES: *Successfully navigate multiple vendors including but not limited to, payer websites and clearinghouse(s) *Produces and maintains department policies, procedures, documentation, and training materials for role specific activities *Upholds "best practices" in day-to-day processes and workflow standardization to drive maximum efficiencies across the team *Must maintain professional and consistent communication with the team and clients to ensure that all needed items are received in a timely manner *Routinely collaborate with department managers to correct problems and improve services *Accurately documents collection activity performed *Identifies inaccurate claim denials, under or over payments, billing errors, and discrepancies to correct to ensure resolution *Informs manager of identified issues or trends *Manages inbound and outbound calls for multiple clients, this may include handling different topics and being a contact between patients and clients *Provides timely resolution of assigned accounts for multiple clients *Successfully submits appeals to insurance companies to obtain reimbursement *Successfully navigates multiple vendors including, but not limited to, payer websites and clearinghouse(s) *Meets specified department performance requirements *Resolves support tickets submitted by clients and assigned to department according to metrics assigned *Manages time and multi-tasks appropriately to meet expectations of management and peers *Remote employee is responsible for sufficient internet connectivity and equipment necessary to complete assigned job duties in efficient manner *Remote employee is responsible to keep work area quiet and organized during scheduled working hoursWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Remote Senior Incident Manager - Night Shift

The Senior Incident Manager is a critical member of the Global Operations team, responsible for leading the end-to-end management of major incidents across a SaaS healthcare platform. This role... More operates with a high degree of autonomy, serves as a technical resource and mentor to peers, and drives continuous improvement across incident management processes. The ideal candidate brings deep technical expertise, strong written and verbal communication skills, and a proven ability to lead under pressure ? from initial triage through post-incident review.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

REMOTE Business Analyst

A large healthcare insurance client is seeking a Business Analyst to partner with internal stakeholders to understand workflows, gather and document requirements, and translate business needs into... More clear, actionable documentation. The role involves guiding business owners through BRD creation, supporting front-end and IT teams with technical business flows, and contributing to data analysis and reporting. Strong communication is key, as roughly half of the role is stakeholder engagement, with the remaining time split between requirements gathering and analytical support.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Remote Senior Incident Manager - Day Shift

The Senior Incident Manager is a critical member of the Global Operations team, responsible for leading the end-to-end management of major incidents across a SaaS healthcare platform. This role... More operates with a high degree of autonomy, serves as a technical resource and mentor to peers, and drives continuous improvement across incident management processes. The ideal candidate brings deep technical expertise, strong written and verbal communication skills, and a proven ability to lead under pressure ? from initial triage through post-incident review.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Application Performance Manager/SRE (AppDynamics)

The Senior Software Development Engineer ? Site Reliability & Application Performance is responsible for ensuring the stability, reliability, and performance of critical applications supporting our... More Third-Party Administrator (TPA) & Payer Solutions department. This role sits at the intersection of software engineering, operations, and SRE practices, with a strong emphasis on Application Performance Monitoring (APM), observability, and continuous improvement of production systems. The colleague in this role will design and implement scalable, resilient solutions; build and maintain observability capabilities; drive incident reduction; and partner closely with engineering, infrastructure, and support teams to improve end-to-end reliability and customer experience.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Remote Environment Manager

A healthcare client is seeking an Environment Manager to own the full lifecycle of our non-production environments ? development, QA, staging, and performance. This individual contributor role is... More responsible for ensuring engineering and QA teams have reliable, well-governed environments available when they need them, while controlling sprawl, cost, and configuration drift. The Environment Manager serves as the central point of coordination between development, QA, DevOps, release management, and infrastructure teams.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less