• Specialist, Config Oversight (healthcare Medical…

    Molina Healthcare (Columbus, OH)
    …communicate written and verbal + Knowledge of verifying documentation related to updates/changes within claims processing system . + Experience using claims ... incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims . ( _Use for claims specific positions only_ )… more
    Molina Healthcare (09/24/25)
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  • General Product and Liability Complex Claim…

    Sedgwick (Toledo, OH)
    …expertise preferred. **Skills & Knowledge** + Subject matter expertise in worker's compensation claims and/or liability claims processing + Ability to obtain ... and strategically manages a complex claim inventory by assessing complex claims issues, utilizing jurisdictional expertise to provide oversight, and directs the… more
    Sedgwick (08/29/25)
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  • Claims Representative - Auto

    Sedgwick (Seven Hills, OH)
    …total loss evaluations, and related expenses to effectively negotiate first and third party claims . + Knowledge of total loss processing , State salvage forms and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Representative - Auto **PRIMARY PURPOSE** : To analyze and process low to… more
    Sedgwick (09/25/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (OH)
    …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... years operational managed care experience (call center, appeals or claims environment). + Health claims processing...center, appeals or claims environment). + Health claims processing background, including coordination of benefits,… more
    Molina Healthcare (10/03/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (Akron, OH)
    …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... years operational managed care experience (call center, appeals or claims environment). + Health claims processing...center, appeals or claims environment). + Health claims processing background, including coordination of benefits,… more
    Molina Healthcare (10/10/25)
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  • Representative II, Accounts Receivable

    Cardinal Health (Columbus, OH)
    …+ Mails all paper claims . + Acts as a subject matter expert in claims processing . + Manages billing queue as assigned in the appropriate system. + Manages ... right things done. **The Accounts Receivable Specialist is responsible for processing insurance claims and billing. They will work within the scope of… more
    Cardinal Health (10/10/25)
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  • Senior QNXT Analyst - Contract Configuration

    Molina Healthcare (Dayton, OH)
    …payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is ... experience **Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. **Preferred Education**… more
    Molina Healthcare (10/01/25)
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  • Process Improvement Lead, Healthcare Claims

    Humana (Columbus, OH)
    …industry + 2+ years of demonstrated expertise in end-to-end healthcare claims operations, including claim ingestion, processing , system navigation, payment ... your opportunity to lead cross-functional initiatives, apply your expertise in healthcare claims , and shape the future of operational excellence in a dynamic,… more
    Humana (10/14/25)
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  • Senior Analyst, Encounters

    Molina Healthcare (Cleveland, OH)
    …statuses and risks, and facilitating calls with cross-functional teams + Claims processing , provider contacting, health data analysis and reporting, ... rejection inventory, and works with other areas including IT, health plan, claims , provider, enrollment, regulators, and external vendors, as needed, to remediate… more
    Molina Healthcare (09/24/25)
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  • Lead Analyst, Payment Integrity - REMOTE

    Molina Healthcare (Dayton, OH)
    …and tests assumptions through data, but leads with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +… more
    Molina Healthcare (09/28/25)
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