- Molina Healthcare (Cincinnati, OH)
- **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager , SIU, the Team Lead is responsible to lead a small team of investigators and provide ... daily investigative activities as a back-up to the SIU Manager . This position will be accountable for tracking on...utilization by providers and recipients. The position will review claims data, medical records, and billing data from all… more
- Zurich NA (Columbus, OH)
- …office/market three days per week. We may, at the sole discretion of the hiring manager , also be open to hiring talent remotely. Zurich Energy is a leading provider ... Executive Underwriter or AVP, Underwriting Director level. The hiring manager will determine the appropriate level based upon the...and 10 or more years of experience in the Claims or Underwriting Support area OR + Zurich Certified… more
- Zurich NA (Cincinnati, OH)
- …at either theUnderwriting Specialist OR Executive Underwriter level . The hiring manager will determine the appropriate level based upon the selected applicant's ... and 6 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance...Support areaOR + Zurich Certified Insurance Apprentice including an Associate Degree and 1 or more years of experience… more
- Bon Secours Mercy Health (Warren, OH)
- …for clinical and operational excellence. **Reports to Title:** Pharmacy Supervisor, Manager , or Director **Summary of Primary Function/General Purpose of Position** ... copies of non-controlled prescriptions (ie Prescription transfers). Technician checking of associate technician work prior to dispensing. *Assisting in the education… more
- CenterWell (Columbus, OH)
- …+ Assist clinical pharmacists in troubleshooting prescription third party claim rejections by accessing and understanding formulary restrictions, plan limitations, ... up tasks for medication reconciliation/education. + Processing of select medication claim updates (lists) as requested by the clinical pharmacists or providers.… more
- Veterans Affairs, Veterans Health Administration (Cleveland, OH)
- …is preferred. The Service Chief will collaborate with the Laboratory Manager , Administrative Officer, and supervisory technologists to provide oversight over the ... Case Western Reserve University SOM. Current academic rank of Associate Professor or higher preferred. Non-citizens may apply. Non-citizens...in spoken and written English. Service Chief or Line Manager . A service chief or line manager … more
- Humana (Columbus, OH)
- …2 ensures contract compliance and performs analysis regarding pharmacy claims . Understands department, segment, and organizational strategy and operating objectives, ... 2 ensures contract compliance and performs analysis regarding pharmacy claims . Understands department, segment, and organizational strategy and operating objectives,… more
- Fifth Third Bank, NA (Cincinnati, OH)
- …previously filed dispute. This may include specialized disputes, including denied claims , reassertions, repeat offenders, and Private Bank client customers. The ... Commercial Code (UCC) and Regulation E and Regulation Z claims . The Analyst uses various bank and vendor systems...functions of the job while referring exception cases to Supervisor/ Manager . Performance Metrics: + Quality: Maintain a high level… more
- OhioHealth (Columbus, OH)
- …system, screens calls for office associates, directing to appropriate office associate , ensures appropriate phone coverage using a computerized system. 5. Provides ... for office as assigned by Office Supervisor and or Manager , to include but not limited to: faxing documentation...Industrial appeal paperwork and retroactive C-9s. 6. Works Industrial claims in the electronic medical record system, to include… more
- Humana (Columbus, OH)
- …responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new ... IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the...EAPG + 2+ years of experience with Optum Rate Manager + 2+ years of experience with Optum WebStrat… more
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