• Medical Coding Appeals Analyst

    Elevance Health (Mason, OH)
    … systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Perform pre- adjudication claims reviews ... position is not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies,… more
    Elevance Health (09/12/25)
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  • Absence Management Team Lead - Coding Team

    Sedgwick (Dublin, OH)
    …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles, reviews, and analyzes management reports… more
    Sedgwick (11/22/25)
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  • Workforce Absence Team Lead

    Sedgwick (Dublin, OH)
    …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles, reviews, and analyzes management reports… more
    Sedgwick (10/07/25)
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  • Pharmacy Tech III Dispensing

    Elevance Health (Mason, OH)
    …the United States. + Experience with PBM/Plan insurance setup and processing and claims adjudication and resolution of reject messaging required. For URAC ... and prescriber encounters, including, but not limited to prescription claim adjudication exceptions, returns, reships, drug recalls, and patient and prescriber… more
    Elevance Health (11/19/25)
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  • Pharm Tech

    ChenMed (Cincinnati, OH)
    …Keeps filing system updated for multiple procedures/processes. + Assists with pharmacy claims adjudication including calling insurances to assess and correct ... pharmacy claims rejections if appropriate. + Other duties as assigned and modified at manager's discretion. **KNOWLEDGE, SKILLS AND ABILITIES:** + Knowledge of… more
    ChenMed (11/03/25)
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  • Special Investigator

    AmeriHealth Caritas (Columbus, OH)
    …Medicaid regulatory compliance;work experience preferred. + Knowledge and; proficiency in claims adjudication standards & procedures preferred. + Solid knowledge ... Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrant; claims billing and practice patterns. + Analyzes data as part of the… more
    AmeriHealth Caritas (10/22/25)
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  • Representative, Pharmacy

    Molina Healthcare (Columbus, OH)
    …of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication , state, NCQA and CMS policies/guidelines, and any ... other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary… more
    Molina Healthcare (11/21/25)
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  • Medicaid Formulary Clinical Pharmacist - CarelonRx

    Elevance Health (Mason, OH)
    …provider communications regarding formulary changes. + Ensures appropriate formulary set-up and claims adjudication . + Serves as a clinical pharmacy resource to ... pharmacy benefit management and pharmacy operations teams. + Ensures compliance of the Medicaid formularies with state/federal mandates and contractual agreements. + Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient,… more
    Elevance Health (11/18/25)
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  • AI Innovation Lead - Data Science Lab

    Guardian Life (Columbus, OH)
    …service logs. + Deliver solutions that enhance underwriting risk assessment, claims auto- adjudication , and customer servicing. Operational Excellence + Establish ... scalable processes, frameworks, and governance models for efficient and responsible AI/ML development, testing, and deployment. + Assess and recommend cutting-edge tools, platforms, and technologies to enhance data science workflows and model lifecycle… more
    Guardian Life (09/12/25)
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  • Claim Examiner - Liability | Remote

    Sedgwick (Columbus, OH)
    …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... Examiner - Liability | Remote **PRIMARY PURPOSE** : To analyze complex or technically difficult general liability claims to determine benefits due; to work with high… more
    Sedgwick (11/22/25)
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