• Director Complex Claims

    Sedgwick (Toledo, OH)
    …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Director Complex Claims **PRIMARY PURPOSE** **:** To be responsible for ... managing SIU investigations of complex fraud schemes involving providers, vendors, attorneys and others;...degree from an accredited college or university preferred. Fraud Claims Law Associate (FCLA), Certified Insurance Fraud Investigator (CIFI),… more
    Sedgwick (05/08/25)
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  • Medical Director -- Claims…

    Humana (Columbus, OH)
    …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
    Humana (05/08/25)
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  • Managed Care Claims Validator / Biller

    CommuniCare Health Services Corporate (Akron, OH)
    …leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, independent living, ... growth, CommuniCare Health Services is currently recruiting for a Claims Validator / Biller to support our Central Billing...team, CBO cash posting team, Business Office Manager, Regional Director of Finance, MDS, Case Management, and others. The… more
    CommuniCare Health Services Corporate (04/27/25)
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  • Director , Digital Health Corporate Counsel

    Otsuka America Pharmaceutical Inc. (Columbus, OH)
    …Founded on Otsuka's rich history in delivering breakthrough innovations to solve complex problems for patients, Otsuka Precision Health (OPH) is the next step ... health experience, one connection at a time, together. The ** Director , Digital Health Corporate Counsel** will be responsible for...with other members of the OPH Legal team on complex matters and matters of first impression, as well… more
    Otsuka America Pharmaceutical Inc. (04/17/25)
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  • Sr Director , Performance Suite Analytics

    Evolent (Columbus, OH)
    …to ensure clean and consistent tracking of Evolent's covered membership and claims + Synthesize complex analyses into succinct presentations for communication ... providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and...connected care journey. We are hiring for a Senior Director to join our Finance Team. The candidate selected… more
    Evolent (05/02/25)
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  • Medical Director - Care Plus - Florida

    Humana (Columbus, OH)
    … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... The Medical Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records,… more
    Humana (04/24/25)
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  • Medical Director - Florida

    Humana (Columbus, OH)
    … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the appropriateness of services… more
    Humana (04/24/25)
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  • Director , Medical Affairs Congress…

    Otsuka America Pharmaceutical Inc. (Columbus, OH)
    ** Director , Medical Affairs Congress Strategy and Execution** The Director , Medical Affairs Congress Strategy and Execution, plays a pivotal role in Otsuka's ... elevate our overall GMA objectives. **Position Overview** Reporting to the Senior Director of Medical Affairs Excellence & Operations, this role will orchestrate… more
    Otsuka America Pharmaceutical Inc. (04/17/25)
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  • Associate Director , Statistical…

    Otsuka America Pharmaceutical Inc. (Columbus, OH)
    …for the maintenance of everyday health** **As the** **Associate Director ,** **Statistical** **Programming** **, you will** **be** **responsible for** **managing** ... **managing** **and develop** **ing** **programmers.** **This position reports to the Director of Statistical Programming and can be based in Rockville, Maryland… more
    Otsuka America Pharmaceutical Inc. (05/02/25)
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  • Associate Director , Thought Leader…

    Otsuka America Pharmaceutical Inc. (Columbus, OH)
    The Associate Director , TLL, Renal Rare Disease, is a field-based, customer facing, non-sales position on Otsuka's Rare Renal team focused on enhancing and improving ... present and educate/present to KOLs and customer groups on complex and scientific/clinical information. + Assess and understand KOL...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
    Otsuka America Pharmaceutical Inc. (05/01/25)
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