- Sumitomo Pharma (Columbus, OH)
- …and evaluation of the adequacy of clinical evidence provided to support proposed claims and assess consistency of proposed claims with FDA-approved labeling + ... of advisory comments and any other interactions regarding use of promotional claims for assigned products, including pre-clearance of launch materials. + Direct and… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …federal laws, regulations and guidelines including PhRMA Code on Interactions with Healthcare Professionals as well as complying with all OAPI standards and policies ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Centene Corporation (Columbus, OH)
- …Ohio are highly preferred.** **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and ... executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste,… more
- Walgreens (Canal Winchester, OH)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- ChenMed (Cincinnati, OH)
- …has been delivered properly and in a timely manner. This is a healthcare position working directly with patients and their families, doctors and other medical ... and professional environment to provide the highest level of quality healthcare to all patients. **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Assists in preparing… more
- Elevance Health (Cincinnati, OH)
- …+ Trains associates on all upskilling of customer service and claims to include providing professional medical service facility correspondence, usage of ... healthcare provider portals, and adjustments. + Serves as an...equivalent background. **Preferred Skills, Capabilities and Experiences:** + FEP Claims or Customer Service experience highly preferred. + Strong… more
- Walgreens (Trenton, OH)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Humana (Columbus, OH)
- …timely and accurate submission of mandated reports, leveraging their understanding of claims data and Medicaid program requirements to drive accurate and timely ... pivot tables and summarizing data into reports and dashboards + Experience working with claims data + Experience working with big and complex data sets within large… more
- CVS Health (Columbus, OH)
- …by ensuring compliance with regulatory and accreditation standards while driving healthcare quality initiatives. This role combines clinical expertise with quality ... requirements. + Apply clinical criteria and policies to member/provider claims and coordinate clinical resolutions with MD support. **Performance Improvement… more
- CenterWell (Columbus, OH)
- …Medical Director, Primary Care relies on medical background and reviews health claims . The Medical Director, Primary Care work assignments involve moderately complex ... factors. The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex… more