• Manager, Medical Economics (Medicaid) - REMOTE

    Molina Healthcare (Cleveland, 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 (08/27/25)
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  • EDI Production Support Analyst

    CVS Health (Columbus, OH)
    …orientation and attention to detail. **Preferred Qualifications** + Background in healthcare or claims processing experience. + Experience with Aetna claims ... processing systems. **Education** + High School diploma/GED and equivalent work experience. + Associates degree or Bachelor's degree is preferred. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is:… more
    CVS Health (10/12/25)
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  • Ambulatory Insurance Clerk Biller I

    Holzer Health System (Bidwell, OH)
    The insurance clerk is responsible for working claims , processing edits, and doing their due diligence to ensure correct claim processing and payments from ... payer policies, and specific payer coding guidelines; follow-up on unpaid claims , process insurance takebacks, overpayments, and refunds, and perform other duties… more
    Holzer Health System (10/01/25)
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  • Credentialing Representative

    Highmark Health (Columbus, OH)
    …Provider File systems. + Experience with the Customer Service inquiry system or claims processing concepts. **Knowledge, Skills and Abilities** + Good written ... by telephone or in writing to obtain additional information while processing their enrollment applications. + Screen incoming applications and paperwork for… more
    Highmark Health (09/06/25)
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  • Principal Data Scientist

    Lumen (Columbus, OH)
    …Utilize Vector Databases and Knowledge Graphs to enhance AI applications in underwriting, claims processing , and customer engagement + Develop data pipelines for ... and automation of complex decision-making processes + Apply natural language processing (NLP) techniques to analyze and extract insights from unstructured data… more
    Lumen (10/08/25)
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  • Pharmacy Coordinator

    Highmark Health (Columbus, OH)
    …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
    Highmark Health (09/09/25)
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  • Remote Pharmacy Technician

    Actalent (Columbus, OH)
    …Technician (PTCB or NHA). + Prior authorization experience. + Familiarity with third-party claims processing . Work Environment: + This is a fully remote ... requests for specialty drugs to delegated vendors or clients for processing . + Contacting providers for additional information to facilitate coverage determination… more
    Actalent (10/04/25)
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  • ADA Accommodation Coordinator

    Sedgwick (Dublin, OH)
    …federal/state leave of absence eligibility review; and to ensure the ongoing processing of claims . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Informs ... Dr Orlando FL 32826 **PRIMARY PURPOSE** **:** To process claims and determine accommodation options following written guidelines and...claimants of documentation required to process claims , required time frames, and claims status… more
    Sedgwick (10/10/25)
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  • Disability Representative

    Sedgwick (Dublin, OH)
    …Security Disability Income (SSDI), and other disability offsets; and to ensure the ongoing processing of claims . **ARE YOU AN IDEAL CANDIDATE?** We are looking ... professional needs. **PRIMARY PURPOSE OF THE ROLE:** To process claims and determine benefits due pursuant to a disability...INCLUDE** + Makes claim determinations to approve non-complex disability claims or makes a recommendation to team lead to… more
    Sedgwick (09/07/25)
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  • CPC Processor

    Datavant (Columbus, OH)
    …following fields would be beneficial: Data Entry, Medical Records, Health Care, Insurance Claims Processing and Proof Reading/Editing of Documents + Ability to ... stay organized while working quickly. Strong attention to detail is also required. + Passing annual Introductory HIPAA examination. (Testing to be given annually in accordance with employee review.) + Required to take and pass a 90-day ROI Certification course… more
    Datavant (10/15/25)
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