• Performance Quality Analyst I - CarelonRx PBM

    Elevance Health (Mason, OH)
    …complex data sets for insightful recommendations. + Familiarity with claims processing, grievance , and appeals processes in healthcare or insurance sectors. + ... Proficiency in applying data analysis tools and techniques to support service quality improvements. + Excellent communication skills for documenting and presenting audit findings and recommendations. Please be advised that Elevance Health only accepts resumes… more
    Elevance Health (08/08/25)
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  • Medical Director - NorthEast Region

    Humana (Columbus, OH)
    …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… more
    Humana (07/25/25)
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  • Sr Analyst, Business

    Molina Healthcare (Dayton, OH)
    …Management + Experience working with complex, often highly technical teams + Appeals & Grievance , healthcare services, or claims background **Preferred License, ... Certification, Association** Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred To all current Molina employees: If you are interested in applying for this position, please apply through… more
    Molina Healthcare (08/08/25)
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  • Specialist, Appeals & Grievances (Medicare…

    Molina Healthcare (Columbus, OH)
    …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member ... appeals and communicating resolution to members and provider (or...and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes,… more
    Molina Healthcare (06/26/25)
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  • Sr Specialist, Member Engagement (Remote)

    Molina Healthcare (OH)
    …Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the ... subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of access and care… more
    Molina Healthcare (08/08/25)
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