- Sedgwick (Dayton, OH)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... Adjuster - Mid Atlantic Region **PRIMARY PURPOSE** **:** To investigate losses or claims internationally on any size National Account (Maintaining a minimum of five… more
- Evolent (Columbus, OH)
- …insights from product strategy analyses and translating them to complex risk -based contract development, and they will partner closely with executives across ... value-based care pursuits. + Support the development of capitated risk partnerships, focusing on cost and use trends, and...and estimate Evolent's ability to reduce costs and improve quality . + Develop models to quantify and articulate value… more
- Molina Healthcare (Cleveland, OH)
- …and you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer ... grievances, and member communications. * Exposure to downstream domains: Enrollment, Claims , Pharmacy/PDE, Network, Stars quality metrics. * Proven record… more
- Sedgwick (Dublin, OH)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... + Supervises Operations Support Services colleagues. + Defines and establishes quality assurance procedures, standards, metrics reporting and auditing. + Trains OSS… more
- Molina Healthcare (Cincinnati, OH)
- …the organizational health care costs for all lines of business and directly impacting Risk Revenue and Quality Compliance. Partner with VP Encounter to ensure ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for establishing enterprise-wide strategy, governance, and oversight of… more
- Sedgwick (Dublin, OH)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... of data; and to support delivery of the highest quality of customer service as a point of contact...data integrity by accurately interpreting the leave and disability claims data coding hierarchy and applying the correct leave… more
- Molina Healthcare (Columbus, OH)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …technology transfers to CDMOs, including documentation review, gap analysis, and risk assessment. + Provide expert technical oversight of upstream manufacturing ... and improvements post-approval. + Author and/or review technical reports, protocols, risk assessments, and relevant sections of regulatory submissions (IND, BLA,… more
- Molina Healthcare (Columbus, OH)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Sedgwick (Columbus, OH)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... regulations, and client service requirements and assure efficient, cost effective, quality program delivery for medical and disability management. + Coordinating and… more