- Sharecare (Columbus, OH)
- …eligibility, benefit education, open enrollment / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, ... + Coordinate issue resolution with providers, payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or… more
- Elevance Health (Mason, OH)
- …Specialist III** is responsible for the discovery, validation, recovery, and adjustments of claims overpayments. May do all or some of the following in relation to ... adjustments. **How you will make an impact:** + Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting,… more
- Elevance Health (Mason, OH)
- …with a preference for those who have experience in healthcare data, particularly in claims , case management, or HEDIS data. + A strong grasp of statistics, ... procedures. + Develops and analyzes business performance reports (eg for claims data, provider data, utilization data) and provides notations of performance… more
- Molina Healthcare (Cincinnati, OH)
- …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more
- CDM Smith (Cincinnati, OH)
- …expertise may be needed throughout the program delivery process. * Supports the claims process by reviewing and validating damage details, scopes of work, and costs ... by providing updates on work status and may evaluate claims and make recommendations to FEMA as to whether...Smith Placement Agreement from the CDM Smith Recruitment Center Manager to receive payment for your placement. Verbal or… more
- Elevance Health (Mason, OH)
- …- Monday. The **Transplant Nurse II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn ... preparation for advancement to the senior level. Within the case management role will within the scope of licensure...treatment plans. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- ABM Industries (Cleveland, OH)
- …and coordinates bus evacuation activities as appropriate * Immediately reports any incidents or claims to Operations Manager or Shift Lead. * Refuel and maintain ... application, please call ###. We will provide you with assistance and make a determination on your request for reasonable accommodation on a case -by- case basis. more
- ABM Industries (Columbus, OH)
- …regular basis to find any unsafe conditions or maintenance issues * Report incidents or claims to Operations Manager or Shift Lead * Drive small and large ... application, please call ###. We will provide you with assistance and make a determination on your request for reasonable accommodation on a case -by- case basis. more
- The Cigna Group (Fairfield, OH)
- …and business strategy, continuously improve processes, and works closely with the manager on development of the team. Support department reporting needs to drive ... to help with collecting requirements, test cases, reviewing and approving test case output, and, as necessary, coordinating release validation with operations. This… more
- CDM Smith (Cleveland, OH)
- …activities, including critical path method (CPM), and scheduling and claims administration. Interprets plans and specifications for clients, contractors, and ... Smith Placement Agreement from the CDM Smith Recruitment Center Manager to receive payment for your placement. Verbal or...vary based on country statutory law but in no case , will the background check precede an interview. CDM… more