• Lead Analyst , Claims…

    Molina Healthcare (Columbus, OH)
    …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting,… more
    Molina Healthcare (06/18/25)
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  • Lead Analyst , Payment Integrity

    Molina Healthcare (Cincinnati, OH)
    …**Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan financial ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
    Molina Healthcare (08/20/25)
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  • Lead Analyst , Configuration…

    Molina Healthcare (OH)
    **Job Description** **Job Summary** We are seeking a highly experienced Lead Analyst , Configuration Oversight to support our Payment Integrity and Claims ... and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen. Experience in… more
    Molina Healthcare (07/24/25)
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  • Financial Systems Analyst

    Medical Mutual of Ohio (OH)
    …and other business needs. + Performs other duties as assigned. **Sr. Financials Systems Analyst ** **Job Summary:** **Performs a lead role in the preparation of ... and runs queries to generate monthly reports for premium, claims and enrollment to be used by several operating...NAIC, and HHS. + Performs other duties as assigned. ** Lead Financials Systems Analyst ** **Job Summary:** **Performs… more
    Medical Mutual of Ohio (08/22/25)
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  • HEDIS Analyst

    Medical Mutual of Ohio (OH)
    …collection. + Participates in required training and performs other duties as assigned. ** Lead HEDIS Analyst ** + Schedules, assigns, and monitors projects and ... knowledge of NCQA and CMS measurement requirements and quality rating systems. ** Lead HEDIS Analyst ** **Education and Experience:** + Bachelor's degree in… more
    Medical Mutual of Ohio (08/16/25)
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  • Grievance/Appeals Analyst I

    Elevance Health (Mason, OH)
    **Title: Grievance/Appeals Analyst I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... unless an accommodation is granted as required by law._ " The **Grievance/Appeals Analyst I** is an entry level position in the Enterprise Grievance & Appeals… more
    Elevance Health (08/23/25)
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  • Special Investigation Unit Lead Review…

    CVS Health (Columbus, OH)
    …in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases ... for clinical and legal review. - Documents all appropriate case activity in case tracking system. - Prepares and presents referrals, both internal and external, in the required timeframe. - Facilitates the recovery of company lost as a result of fraud matters.… more
    CVS Health (08/14/25)
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  • Actuarial Analyst III

    Elevance Health (Mason, OH)
    **Actuarial Analyst III** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... accommodation is granted as required by law. The **Actuarial Analyst III** completes very diverse and complicated projects and...Make An Impact:** + Analyze and monitor weekly incurred claims , paid claims , pharmacy, lab results, and… more
    Elevance Health (08/23/25)
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  • Analyst , Integration Quality

    Evolent (Columbus, OH)
    …Stay for the culture. **What You'll Be Doing:** Job Description ** Analyst , Integration Quality** Integration testing in the healthcare ecosystem requires complete ... exercised to ensure source to target integrity. The IQ Analyst (IQA) performs analysis, reporting, and technical testing across...to escalate risks and issues in coordination with the lead / manager for status reporting + Responsible to… more
    Evolent (08/13/25)
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  • Advanced Analytics Analyst Senior - Medical…

    Elevance Health (Cincinnati, OH)
    **Advanced Analytics Analyst Senior - Medical Economics** **Location:** Atlanta, GA; Norfolk, VA; Indianapolis, IN; Cincinnati, OH; Chicago, IL (preferred). This ... passionate about transforming American healthcare delivery. The **Advanced Analytics Analyst Senior** measures financial performance of core Carelon products… more
    Elevance Health (08/20/25)
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