- UNUM (Des Moines, IA)
- …Rehabilitation. This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across Unum US product lines. The ... and internal workflow standards as set forth in the Benefits Center Claims Manual, underwriting manual, and associated documentation. The incumbent adheres to… more
- Molina Healthcare (IA)
- …supervised learning and rule-based logic to detect potentially incorrectly paid claims . + Contribute to improve data quality, perform data audits, identify ... discrepancies and resolve issues. + Support the identification of opportunities for operational improvement or growth based on analytical findings. + Areas of exposure may include: + Economics/Finance + Data Analysis / Science + Fraud, Waste, and Abuse… more
- Molina Healthcare (Iowa City, IA)
- …affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable ... financial and even clinical insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care… more
- Molina Healthcare (Davenport, IA)
- …affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable ... financial and even clinical insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care… more
- Molina Healthcare (Sioux City, IA)
- …member eligibility and covered benefits, Provider Portal, and status of submitted claims . * Ability to effectively communicate in a professionally setting. **Job ... Qualifications** **REQUIRED EDUCATION** : HS Diploma or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment… more
- Molina Healthcare (Sioux City, IA)
- …Architectural compliance and governance. **Knowledge/Skills/Abilities** + Healthcare knowledge in Claims Processing and Payments + Develops software (hands on code ... development) to meet key business objectives. + Understands and applies SW and applications development methodologies in adherence to SW development standards + Designs and develops SW applications or systems solving specific business or processing problem… more
- Molina Healthcare (IA)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of SQL ... 2005/2008 SSRS report development + Familiar with relational database concepts, and SDLC concepts **Preferred Education** Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. **Preferred Experience** 3 - 5 years… more
- Molina Healthcare (Davenport, IA)
- …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
- Molina Healthcare (Davenport, IA)
- …Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS ... measure deep dive to support HEDIS audit and revenue at risk reporting. + Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex as… more
- Molina Healthcare (Davenport, IA)
- …is hiring for a Medicare Appeals & Grievances Specialist. This position is remote and will be working Pacific Standard hours. Highly Qualified Candidates Will Have ... to detail + AOR/IRE understanding highly preferred Provides support for claims activities including reviewing and resolving member and provider complaints, and… more