- Elevance Health (Mason, OH)
- …with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities ... prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Mason, OH)
- …duties may include, but are not limited to: + Researches and interprets claims issues while ensuring good, accurate and timely customer service for our pharmacy ... custom reports for internal and external clients, such as claims , drug utilization and impact reports to our clients...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Mason, OH)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Mason, OH)
- …Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider ... and specialty care procedures. + Recommends policy changes and claims system changes to pursue cost savings. + Reviews...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Cincinnati, OH)
- …Analytics Analyst Senior** measures financial performance of core Carelon products leveraging claims , authorization, and membership data to tell a detailed story to ... financial services highly preferred. + Comprehensive understanding of medical claims data. + Intermediate to Advanced expertise with SQL,...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Mason, OH)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Independence, OH)
- **Telephonic Nurse Case Manager II** **Sign On Bonus: $3000** **Location** : This role enables associates to work virtually full-time, with the exception of required ... states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for performing care management within the scope… more
- Elevance Health (Mason, OH)
- **Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... is granted as required by law._ The **Nurse Case Manager II** will be responsible for care management within...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Elevance Health (Mason, OH)
- …care management treatment plans. + Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management ... BA/BS or higher in a health related field or certification as a care manager preferred. + Knowledge of medical management process and ability to interpret and apply… more
- Elevance Health (Independence, OH)
- …law. The **Group Underwriter, Senior** is responsible for determining acceptability of insurance risks and appropriate premium rates for large, complex renewal and ... or benefit change increments or decrement. + Communicates with sales, administration and claims to assess the rating and administrative impact or benefit and plan… more