- Molina Healthcare (Columbus, OH)
- …claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed ... on databases and ensure adherence to business and system requirements of customers as it pertains...presenting and documenting is required, + Experience with Medicare, Medicaid and Marketplace is required. + Medical coding experience… more
- Prime Therapeutics (Columbus, OH)
- …change process + Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid ) + Other duties as assigned ... drives every decision we make. **Job Posting Title** Compliance Analyst Principal - Remote **Job Description** The Compliance Principal...**Education & Experience** + Bachelor's degree in business , healthcare , or related area of study,… more
- Elevance Health (Mason, OH)
- **Actuarial Analyst III** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... unless an accommodation is granted as required by law. The **Actuarial Analyst III** completes very diverse and complicated projects and performs very complex… more
- Prime Therapeutics (Columbus, OH)
- …+ Other duties as assigned **Education & Experience** + Bachelor's degree in business , healthcare , or related area of study, or equivalent combination of ... passion and drives every decision we make. **Job Posting Title** Compliance Analyst Principal (Performance and Oversight) - Remote **Job Description** The Compliance… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Actuarial Analyst 2, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to ... Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to… more
- Humana (Columbus, OH)
- …actuarial and business needs for specific product lines. The Actuarial Analyst 2, General work assignments are varied and frequently require interpretation and ... community and help us put health first** The Actuarial Analyst 2, General provides actuarial support across a broad...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Prime Therapeutics (Columbus, OH)
- …+ Other duties as assigned **Education & Experience** + Bachelor's degree in business , healthcare , or related area of study, or equivalent combination of ... and drives every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance… more
- Medical Mutual of Ohio (OH)
- …identify actionable opportunities for quality improvement across all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid ). Integrates ... report performance on key quality indicators, including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), STARS, Consumer Assessment of … more
- CVS Health (Columbus, OH)
- …every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team within ... role, you will manage complex investigations into suspected and known acts of healthcare fraud, waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- CVS Health (Columbus, OH)
- …conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with ... state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. - Demonstrates high level of knowledge and… more