• Claims Quality Review…

    Cognizant (Columbus, OH)
    ** Claims Quality Review ** ( remote ) This is a remote position open to any qualified applicant that lives in the United States. **Summary:** Our ... quality standards, processes and procedures and policies + Ensures the claims processing reps adhere to predetermined quality assurance standards and the… more
    Cognizant (10/09/25)
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  • Claims Process Executive ( remote )

    Cognizant (Columbus, OH)
    ** Claims Process Executive ( remote )** **JOB PURPOSE:** Claim Processors will review claim submissions, verify information, adjudicate the claim as per claim ... the business requirements. **ESSENTIAL FUNCTIONS** : + Examining and entering basic claims for appropriateness of care and completeness of information in accordance… more
    Cognizant (10/04/25)
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  • Medical Claims Processor - Remote

    Cognizant (Columbus, OH)
    …and coverage guidelines and regulations + Experience in the analysis and processing of claims , utilization review / quality assurance procedures + Must be able ... to transform a variety of business operations. We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Medical** ** Claims … more
    Cognizant (10/10/25)
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  • Executive Director of R&D Global Quality…

    Otsuka America Pharmaceutical Inc. (Columbus, OH)
    …Summary** We are seeking an experienced and dynamic Executive Director of R&D Global Quality to join our team. This pivotal role will be responsible for leading a ... global team focused on R&D Quality . This global role includes direct reports in the...be reported periodically to Senior Management through the Management Review process to ensure alignment with Company policy and… more
    Otsuka America Pharmaceutical Inc. (08/14/25)
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  • Team Leader - Liability | Remote

    Sedgwick (Columbus, OH)
    …+ Compiles reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, ... Financial Services & Insurance Team Leader - Liability | Remote **PRIMARY PURPOSE** : To supervise the operation of...authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated … more
    Sedgwick (10/10/25)
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  • Analyst, Quality Analytics & Performance…

    Molina Healthcare (Columbus, OH)
    …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 ... **Job Description** **Job Summary** The Analyst, Quality Analytics and Performance Improvement role will support...and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity… more
    Molina Healthcare (09/18/25)
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  • Sr. AI Business Analyst - Remote

    Prime Therapeutics (Columbus, OH)
    …requestors to resolve questions regarding requested software changes, and participate with Quality Assurance and UAT resources to review related test cases ... drives every decision we make. **Job Posting Title** Sr. AI Business Analyst - Remote **Job Description** **Are you a Business Systems Analyst with an AI background?… more
    Prime Therapeutics (10/01/25)
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  • Recovery & Resolution Analyst - Remote

    Prime Therapeutics (Columbus, OH)
    …combined pharmacy and PBM experience to include: 1 year of work experience in claims processing in an operations, audit or quality assurance environment, and 1 ... decision we make. **Job Posting Title** Recovery & Resolution Analyst - Remote **Job Description** The Recovery & Resolution Analyst is responsible for recovering… more
    Prime Therapeutics (10/04/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Akron, OH)
    …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... submitted, to ensure medical necessity and appropriate/accurate billing and claims processing. + Identifies and reports quality ...years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
    Molina Healthcare (09/06/25)
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  • Property Management Manager ( Remote )

    CBRE (Columbus, OH)
    Property Management Manager ( Remote ) Job ID 241052 Posted 06-Oct-2025 Service line GWS Segment Role type Full-time Areas of Interest Property Management Location(s) ... Remote - US - Remote - US...Vendor Management: Source, vet, and handle service providers, ensuring quality and cost-effectiveness. + Documentation: Maintain detailed records of… more
    CBRE (10/07/25)
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