- Prime Therapeutics (Columbus, OH)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Sr . Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & ... Complaints Senior Compliance Analyst assists in the implementation...stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with business… more
- Evolent (Columbus, OH)
- …fostering trust, expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. + Process and validate ... raw unadjudicated claims data. **Qualifications Required and Preferred:** + Bachelor's degree, preferably with a quantitative major (eg actuarial, statistics, … more
- Molina Healthcare (OH)
- …the Health Care environment **Job Duties** The Operational/Regulatory Oversight Sr . Analyst works with health plans and operations departments to assess, ... ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr . Analyst develops and performs audits and oversight functions involving… more
- Molina Healthcare (Cleveland, OH)
- **Job Description** **Job Summary** The Sr Analyst , Encounters is responsible for monitoring inbound and outbound encounter processes and ensuring timely, ... Governance and Operations Reviews + Performs root cause analysis of claims and encounter data and develops recommendations based on data and industry knowledge.… more
- Elevance Health (Cincinnati, OH)
- **Advanced Analytics Analyst Senior - Medical Economics** **Location:** Atlanta, GA; Norfolk, VA; Indianapolis, IN; Cincinnati, OH; Chicago, IL (preferred). This ... leaders passionate about transforming American healthcare delivery. The **Advanced Analytics Analyst Senior ** measures financial performance of core Carelon… more
- Evolent (Columbus, OH)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Senior Analyst , Healthcare Analytics Consultant** The Client Analytics team provides a ... the impact of our specialty programs and administrative platform. **Role Overview** The Senior Analyst role on Client Analytics will support both internal teams… more
- Molina Healthcare (OH)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing ... operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms (eg, PMPM,… more
- Medical Mutual of Ohio (OH)
- …Analysts. + Participates in required training and performs other duties as assigned. ** Sr HEDIS Analyst ** + Leads analytical and technical support for the ... Advanced knowledge of health insurance industry and health plan operations . + Ability to utilize certified HEDIS software. +...languages (SAS) and data visualization tools such as Tableau. ** Sr HEDIS Analyst ** **Education and Experience:** +… more
- Molina Healthcare (Cincinnati, OH)
- **JOB DESCRIPTION** **JOB DESCRIPTION** **Job Summary** The ** Senior Analyst , Utilization Management** plays a critical role in supporting clinical and ... advanced SQL queries to extract, validate, and analyze healthcare data, including claims , authorization, pharmacy, and lab datasets. * Build and maintain efficient… more
- Highmark Health (Columbus, OH)
- …MUST BE A US CITIZEN This position serves as a key liaison between Claims Operations , Customer Service, Regulatory Affairs, IT, Legal and other departments, ... federal, and industry regulatory changes and assess their potential impact on Claims Operations , Customer Service and other operational areas processes and… more