- Highmark Health (Columbus, OH)
- …and/or create analytics and reporting solutions aligned to the Quadruple Aim of Healthcare : lower per capita health care costs, improved outcomes from and quality of ... in varied and complex data; and articulates analytic findings, business implications, and recommendations to realize identified opportunities. **ESSENTIAL… more
- CVS Health (Columbus, OH)
- …every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team within ... role, you will manage complex investigations into suspected and known acts of healthcare fraud, waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- CVS Health (Columbus, OH)
- …conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with ... in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases… more
- Molina Healthcare (Akron, OH)
- …Qualifications** **REQUIRED QUALIFICATIONS:** + At least 7 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) ... coordination, and ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** ** Business Leadership & Operational Ownership**… more
- Molina Healthcare (OH)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... meet data analysis and database development needs. + Reviews, evaluates, and improved business logic and data sources. + Resource to staff for mentoring, coaching,… more
- Elevance Health (Cincinnati, OH)
- …and identify impact on existing programs. + Conduct comprehensive analysis of healthcare data, claims , and financial reports to identify trends, patterns, ... ** Business Information Consultant Senior - Provider Economics** The...for forecast and month-end results. + Serve as an analyst and advisory to both internal and external stakeholders,… more
- Cleveland Clinic (Cleveland, OH)
- …Preferred qualifications for the ideal future caregiver include: + Knowledge of healthcare operations + Claims experience - waystar, experian, availity, other ... Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare . Cleveland Clinic is recognized as one of the top hospitals in… more
- Public Consulting Group (Columbus, OH)
- …change, improve access to health care, maximize program revenue, improve business processes, and achieve regulatory compliance. Services: + Third Party Administrator ... Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory...Studies + Cost Settlement and Supplemental Payment Strategies + Healthcare Access and Markets A Test Leader oversees the… more