• Grievances & Appeals Representative

    Humana (Columbus, OH)
    …inbound call center or related customer service experience + Previous experience processing medical claims + Bilingual (English and Spanish); with the ability to ... and speak English and Spanish + Experience with the Claims Administration System (CAS) + Knowledge of medical...and compassionately interact with geriatric population **Additional Information** **Work at Home Guidance** To ensure Home more
    Humana (06/04/25)
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  • Senior Encounter Data Management Professional

    Humana (Columbus, OH)
    …skills to make an impact** **Required Qualifications** **5 years of medical claims processing/auditing or encounter data management experience** **Demonstrated ... team leadership experience** **Demonstrated experience in managing projects effectively** ** Medical claims experience** **Additional Information** **_This position… more
    Humana (05/31/25)
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  • AVP, Utilization Review & Pharmacy

    Zurich NA (Columbus, OH)
    …Review & Pharmacy. This is a fully remote position, offering the flexibility of a home -based office. As the AVP of Utilization Review & Pharmacy, you will lead and ... the review of clinical services for the determination of medical necessity and appropriateness of care of our insureds'...for business results and works with Managed Care and Claims leadership to create and align utilization and pharmacy… more
    Zurich NA (05/22/25)
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  • Senior Business Intelligence Engineer

    CenterWell (Columbus, OH)
    …to make an impact** **Key Responsibilities:** + **Operational Reporting:** Oversee the medical and prescription claims processes, including quality, audits, and ... self-provided internet service of Home or Hybrid Home /Office employees must meet the following criteria: At...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
    CenterWell (05/31/25)
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  • Appeals Licensed Practical Nurse

    Evolent (Columbus, OH)
    …who review the appeal, the claims department to review provider post-service claims for medical necessity, and managers for direction and leadership. The ... and accomplishments. **What You Will Be Doing:** Communicates with medical office personnel to obtain pertinent clinical history and...require that all employees have the following technical capability at their home : High speed internet over… more
    Evolent (05/16/25)
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  • Director, Actuarial Services - Transform…

    Evolent (Columbus, OH)
    …**Technical Requirements:** We require that all employees have the following technical capability at their home : High speed internet over 10 Mbps and, ... the organization and patient health. This role supports both medical cost management activities and business development efforts. **What...employees, the ability to plug in directly to the home internet router. These at - home more
    Evolent (03/22/25)
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  • Lead Software Engineer

    Humana (Columbus, OH)
    …charity matching program + Network Resource Groups (NRGs) + Career development opportunities **Work- At - Home Requirements** To ensure Home or Hybrid Home ... to work effectively, the self-provided internet service of Home or Hybrid Home /Office employees must meet the following criteria: At minimum, a download… more
    Humana (06/07/25)
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  • Senior Financial Reporting Analyst

    Humana (Columbus, OH)
    …subsequently be informed if you will be moving forward to next round of interviews. **Work at Home Guidance** To ensure Home or Hybrid Home /Office ... all business areas such as: Finance, Network, Health Services, Claims and Actuarial **Use your skills to make an...Home /Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and… more
    Humana (05/29/25)
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  • Market Entry Capture Strategy Lead

    Humana (Columbus, OH)
    …to work effectively, the self-provided internet service of Home or Hybrid Home /Office employees must meet the following criteria: At minimum, a download ... rethink routine and seek talent with the following attributes + Creative - Adept at research to determine the opportunity and a structured yet flexible approach to… more
    Humana (06/04/25)
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  • Senior Analyst, Healthcare Analytics Consultant

    Evolent (Columbus, OH)
    …**Technical Requirements:** We require that all employees have the following technical capability at their home : High speed internet over 10 Mbps and, ... Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization...employees, the ability to plug in directly to the home internet router. These at - home more
    Evolent (06/06/25)
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