- Molina Healthcare (OH)
- For this position we are hiring for a float team to support PEGA UM systems throughout multiple states.** **JOB DESCRIPTION** **Job Summary** Molina Healthcare ... and knowledge of Interqual / MCG guidelines. Experience using PEGA **Preferred License, Certification, Association** Active, unrestricted Utilization Management… more
- PNC (Cleveland, OH)
- …Marketing Strategy to design PNC's one-to-one customer decisioning approach to be built in Pega Customer Decision Hub (CDH). The ideal candidate has experience as a ... Pega Senior or Lead Decision Architect in Pega CDH 8 or higher. The responsibilities of this role will include but are not limited to: * Understanding business… more
- Molina Healthcare (Columbus, OH)
- …as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as ... required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina… more
- Elevance Health (Cincinnati, OH)
- …& CIW; WEBSTRAT; Authorization Overwrite Tool (AO Tool) .Net UI; Claims Workstation Pega UI. + Have sound claims process and data knowledge including: Claims Train ... data, CAST Train data; CAST Lights On mgmt., E2E claim lifecycle Vetting; FICR; MGCT# Post adjudication; CPEC-Claims Payment Extract and Capitation; CIFT, CFE; GBD IT Pre/Post-Adjudication; COPS; UM MATCH LOGIC; PROVIDER/PRICING CONFIG utilization. + Data &… more
- Humana (Columbus, OH)
- …Qualifications** + Experience with NBA or personalization platforms such as PEGA , Salesforce Interaction Studio, Adobe Journey Optimizer, or similar + Familiarity ... with healthcare regulations (eg, HIPAA) and responsible data usage practices. + Experience working in highly regulated industries or with enterprise AI governance frameworks + Master's degree **Additional Information** **This role is a 100% remote role… more
- PNC (Strongsville, OH)
- …aligned with strategic goals. Preferred Experience: - Jira - Confluence - Pega - Offers and Fulfillment Business Processes **Job Description** + Provides guidance ... and advice on business architecture designs in complex projects, resolves difficult problems and ensures that all deliverables meet high standards in quality. + Designs business architecture procedures, such as the target operating model and roadmap, while… more
- Molina Healthcare (Cleveland, OH)
- …: + 1-3 years + Preferred Systems Training: + Microsoft Office + Genesys + Salesforce + Pega + QNXT + CRM + Verint + Kronos + Microsoft Teams + Video Conferencing + ... CVS Caremark + Availity To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal… more
- Prime Therapeutics (Columbus, OH)
- …SAS + Experience with industry models and standards (HL7, FHIR, NCPDP, Pega Foundation for Healthcare, Salesforce Health Cloud) + Experience working with regulatory ... compliance requirements (HIPAA and/or PCI) + Previous experience in PBM / health care industry + Strong experience with software development life cycle and project management principles + In-depth knowledge of two or more architectural domains (application,… more
- Highmark Health (Columbus, OH)
- …+ Data Warehousing + COBAL + Visual Basic + C + C++ SAS + Java/JavaScript Framework + PEGA + CSS3 + Mobile + JSON + Cognos + Hadoop + SQL + J2EE + HTML5/XML + ... Waterfall + Agile **Language (other than English)** None **Travel Requirement** 0% -25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-Based Teaches / trains others regularly Frequently Travel regularly from the office to various… more
- Prime Therapeutics (Columbus, OH)
- …(HL7, FHIR, NCPDP, Teradata Healthcare Data Model, IBM Healthcare Data Model, Pega Foundation for Healthcare, Salesforce Health Cloud, etc.) + Experience with ... relational, document, message and business event data stores and technologies + Experience working with regulatory compliance requirements (HIPAA and/or PCI) + Previous experience in PBM / health care industry + Strong experience with software development life… more