- Molina Healthcare (OH)
- …group (DRG) validation tools and process improvements - ensuring that member medical claims are settled in a timely fashion and in accordance with quality reviews ... and training, auditing and production management resources. * Identifies potential claims outside of current concepts where additional opportunities may be… more
- Molina Healthcare (Cleveland, OH)
- …to detail + AOR/IRE understanding highly preferred Provides support for claims activities including reviewing and resolving member and provider complaints, and ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Sedgwick (Cincinnati, OH)
- …Saturdays: 10am-6pm **PRIMARY PURPOSE** **:** To provide excellent service to callers regarding claims for multiple lines of business; to expedite the claims ... assisting with questions and solving problems related to the claims application and servicing processes. + Educates and informs...required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions… more
- Sedgwick (Cincinnati, OH)
- …professional needs. **PRIMARY PURPOSE** **:** To provide excellent service to callers regarding claims for multiple lines of business; to expedite the claims ... assisting with questions and solving problems related to the claims application and servicing processes. + Educates and informs...required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions… more
- Molina Healthcare (Dayton, OH)
- JOB DESCRIPTION Provides support for claims activities including reviewing and resolving **Provider No Surprises Act** cases in accordance with the standards and ... ensure that internal and/or regulatory timelines are measured correctly. * Researches claims using support systems to determine **Provider No Surprise Act** cases… more
- Sedgwick (Columbus, OH)
- …you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your ... of clients across the globe, handling complex cases and claims + Collaborate with a talented and supportive team...required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions… more
- Molina Healthcare (Columbus, OH)
- …clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains ... resolution within 30 days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to… more
- Molina Healthcare (OH)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. **Job Summary** Provides support for medical claim and ... DUTIES:** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made,… more
- Zurich NA (Columbus, OH)
- …investigates, evaluates, and concludes low exposure, low complexity, mechanical breakdown claims by following established protocols to ensure that claims ... the most efficient, effective way while delivering a customer-centric claims service. Determines causes of failures and reviews specific...and working across work groups + ASE At Zurich, compensation for roles is influenced by a variety of… more
- OhioHealth (Columbus, OH)
- …addressing concerns impacting OhioHealth's liability with respect to professional liability claims and incidents and the review and oversight of practitioner claim ... trends from the organization's claims /incidence database. In partnering with System Quality, this role also identifies primary areas of risk and works with Quality… more