- Molina Healthcare (Akron, OH)
- …enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of claims ... of experience working in the group health business preferred, particularly within claims processing or operations. + A demonstrated working knowledge of Local, State… more
- Elevance Health (Mason, OH)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5… more
- Prime Therapeutics (Columbus, OH)
- …with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness & ... accuracy of Prime's financial pricing programs against adjudicated claims to identify trends and draw insights to provide pricing recommendations + Apply… more
- Travelers Insurance Company (Columbus, OH)
- …Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to ... optimize claim results. Travelers' Cyber Claim Team is responsible for handling claims focusing on cyber privacy and security breach incident response, computer… more
- Marathon Petroleum Corporation (Findlay, OH)
- …and/or long-term disability. KEY RESPONSIBILITIES + Manages all aspects of employee injury claims , including but not limited to timely reporting of injuries to Third ... return to work and requesting settlement authority to resolve claims . + Ensures compliance with all state and federal...(4) years of relevant experience in handling employee injury claims , including Workers Compensation, or insurance claims … more
- Molina Healthcare (South Charleston, OH)
- …**I** **E** **N** **C** **E:** + Min. 6 years' experience in healthcare claims review and/or member dispute resolution. + 2 years leadership experience + Experience ... reviewing all types of medical claims (eg HCFA 1500, Outpatient/Inpatient UB92, Universal Claims... claims (eg HCFA 1500, Outpatient/Inpatient UB92, Universal Claims , Stop Loss, Surgery, Anesthesia, high dollar complicated … more
- Molina Healthcare (Cincinnati, OH)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... in QNXT and act as a QNXT SME. + Networx / Pricer and claims experience is highly preferred. + SQL is highly preferred. **JOB QUALIFICATIONS** **Required Education**… more
- Humana (Columbus, OH)
- …community and help us put health first** Design and maintain Medicaid claims analytics dataset using Databricks. Conduct in-depth analysis of healthcare claims ... Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. Maintain dashboards to communicate key trends to stakeholders. The… more
- Molina Healthcare (Columbus, OH)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... the development, implementation and maintenance of provider data in the claims payment system. * Supports critical business strategies by providing systematic… more
- TEKsystems (Beachwood, OH)
- …involves managing prescriptions, reviewing medical records and policies, and handling claims within a dynamic and growing healthcare environment. Responsibilities + ... to obtain necessary follow-up information. + Manage appeals and denials within claims , ensuring timely and effective resolution. Essential Skills + Proven experience… more