- Humana (Columbus, OH)
- …The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on problems of ... the appropriateness and medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance… more
- ZOLL Medical Corporation (Columbus, OH)
- …involving continuing provision of ZOLL products/services with physicians, other healthcare professionals and support staff.Essential Functions + Visit ZOLL customers ... clinically appropriate cases. Determine independently and work collaboratively with office staff/ healthcare provider to bring patient's case to the staff's attention… more
- Elevance Health (Mason, OH)
- …+ Serves as a resource for complex issues and interpretation of claims , provider contracts and data, eligibility, member contracts, benefits, clinical decisions, ... minimum of 3 years of management experience in the healthcare industry; or any combination of education and experience...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Elevance Health (Mason, OH)
- …organizations. **How you will make an impact:** + Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network ... to create predictive impact decision making tools. + Performs healthcare cost analysis to identify strategies to control costs....dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Humana (Columbus, OH)
- …+ 2 or more years of Appeals experience + 1 or more years' Healthcare experience + Strong data entry skills + Intermediate experience with Microsoft Word and ... frame. + CAS, MedHOK experience strongly preferred + Previous experience processing medical claims **Required Work Schedule** This is a remote role and will provide… more
- Humana (Columbus, OH)
- …team throughout the sales cycle. + Collect and organize RFP info (census, claims , RAF, etc.) and track down missing information from Broker/Client + Support sold ... potential on market outcomes **Preferred Qualifications** + Bachelor's Degree. + Healthcare or insurance industry experience. + Bilingual with the ability to… more
- Elevance Health (Mason, OH)
- …organizations. **How you will make an impact:** + Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network ... payor or provider environment; considerable experience in statistical analysis and healthcare modeling; or any combination of education and experience, which would… more
- Datavant (Columbus, OH)
- …company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right ... team. Together, we're rising to the challenge of tackling some of healthcare 's most complex problems with technology-forward solutions. Datavanters bring a diversity… more
- City of Cincinnati (Cincinnati, OH)
- …investigations/response, a ttend periodic project meetings - PreConstruction, Progress, Claims , etc. to assess staff and contractors' performance and understand ... age, amount of coverage, and various additional factors. Flexible Benefits Plans Healthcare Flex Spending Account City employees can participate in the Healthcare… more
- City of Cincinnati (Cincinnati, OH)
- …set for the Section/Unit are being met. Investigate and process damage claims , accidents, and employee conduct. Assist and/or lead in disciplinary related processes. ... age, amount of coverage, and various additional factors. Flexible Benefits Plans Healthcare Flex Spending Account City employees can participate in the Healthcare… more