• Medical Claim Review Nurse (RN)

    Molina Healthcare (Akron, OH)
    …appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing . + Identifies and reports quality of care issues. + ... work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
    Molina Healthcare (09/06/25)
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  • ACA/Medicare Risk Adjustment Analyst Sr.

    Baylor Scott & White Health (Columbus, OH)
    …appropriate statistical trend analysis. + Performs root cause analysis of claims /encounters processing and submission issues; develops recommendations based on ... and outbound encounter process. + Monitors and oversees the end-to-end claims encounter management workflow. + Identifies and interprets encounter data, submission… more
    Baylor Scott & White Health (10/03/25)
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  • Healthcare Compliance Auditor - Enterprise Risk

    Bon Secours Mercy Health (Cincinnati, OH)
    …+ Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal ... periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality control reviews, internal… more
    Bon Secours Mercy Health (10/13/25)
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  • PRN Crisis Care Triage (RN)

    Sedgwick (Columbus, OH)
    …to apply critical thinking under pressure + Knowledge of the insurance industry and claims processing + Knowledge of field case management + Excellent oral and ... the claim. + Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and… more
    Sedgwick (10/10/25)
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  • Recovery & Resolution Analyst - Remote

    Prime Therapeutics (Columbus, OH)
    …combined pharmacy and PBM experience to include: 1 year of work experience in claims processing in an operations, audit or quality assurance environment, and 1 ... and understanding of the point of sale and on-line pharmacy claims processing environment + Excellent oral, written and interpersonal communication skills +… more
    Prime Therapeutics (10/04/25)
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  • Associate Analyst, Provider Configuration (Remote)

    Molina Healthcare (Dayton, OH)
    …Ensure that provider information is loaded accurately to allow for proper claims processing , outbound reporting and directory processes. **JOB QUALIFICATIONS** ... for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims… more
    Molina Healthcare (10/05/25)
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  • Specialist, Provider Network Administration (EST…

    Molina Healthcare (Columbus, OH)
    …Provider Network Operations, Hospital or Physician Billing, or similar. + Claims processing background including coordination of benefits, subrogation, and/or ... and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system… more
    Molina Healthcare (08/14/25)
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  • Senior Agentic AI Data Scientist

    The Hartford (Columbus, OH)
    …Our current focus is developing agentic AI workflows to automate and transform claims processing , while also advancing other strategic AI projects across ... the insurance industry in AI. The AI Accelerator - Claims & Operations is at the heart of that...experiments with solid methodology and meaningful metrics. + Data processing & Analysis: While our focus is on unstructured… more
    The Hartford (08/22/25)
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  • Performance Quality Auditor I

    Elevance Health (Mason, OH)
    …within the enterprise. Included are processes related to enrollment and billing and claims processing , as well as customer service written and verbal inquiries. ... 2 years experience with the company in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance… more
    Elevance Health (10/02/25)
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  • Senior Analyst, Medical Economics (Vbc) - Remote

    Molina Healthcare (OH)
    …of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing , etc.) + Knowledge of healthcare financial terms ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
    Molina Healthcare (08/31/25)
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