- 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,...and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new… more
- Molina Healthcare (Cincinnati, OH)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. **KNOWLEDGE/SKILLS/ABILITIES** + Audits loaded provider… more
- Molina Healthcare (Cincinnati, OH)
- …conducts research to resolve customer initiated issues related to core systems processing, and coordinates and manages project teams in the development ... + 3-5 years' experience in a combination of applicable business and business systems + Computer Science or Info tech + Testing experience required + Data… more
- CVS Health (Columbus, OH)
- …in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases ... information and identifying information resources. * Ability to utilize company systems to obtain relevant electronic documentation. * Ability to travel and… more
- Highmark Health (Columbus, OH)
- …scope and complexity + 5 years with coding languages, analytical software, systems , tools and processes using claims , clinical, enrollment and provider ... data + 3 years of project leadership in a complex, matrixed environment (payer and/or provider preferred) + 3 years of providing analytical consultation to clinical, administrative, operational and financial stakeholders **Preferred** + None **LICENSES or… more
- Prime Therapeutics (Columbus, OH)
- …+ A bachelor's degree in business intelligence, management information systems , mathematics, statistics, analytics, computer and information sciences or similar ... years of work experience. + Prior experience as a Business Intelligence Developer/ Analyst or Data Analyst supporting business intelligence, reporting, analytics… more
- Highmark Health (Columbus, OH)
- …work closely with the section's Accountant, Accounting Coordinators, Associate Analyst , providing, guidance, feedback, training, motivation, and support. This team ... for non-payment, Completing write-offs as appropriate, Coordinating AR issues affecting claims or inquiry processing with Membership and Billing personnel.Lead or… more
- Cleveland Clinic (Cleveland, OH)
- …degree may offset years of experience + Experience with implementing and supporting major systems in a clinical or system analyst capacity + Experience in ... initiatives by enhancing the efficiency, accessibility and effectiveness of information systems . Additionally, you will serve as a strategic advisor to various… more
- Molina Healthcare (Columbus, OH)
- …staff for mentoring, coaching, and analysis questions. + Reviews Health Plan analyst work products to ensure accuracy and clarity. + Reviews regulatory reporting ... Education** Bachelor's Degree in Finance, Economics, Math, Computer Science, Information Systems , or related field **Required Experience** + 3 years management or… more
- Molina Healthcare (OH)
- …staff for mentoring, coaching, and analysis questions. + Reviews Medical Economics analyst work products to ensure accuracy and clarity. + Reviews regulatory ... Education** Bachelor's Degree in Finance, Economics, Math, Computer Science, Information Systems , or related field **Required Experience** + 3 years management or… more