• Manager Claim Processing

    CVS Health (Columbus, OH)
    …of team by providing strategic leadership and overseeing the operations of the claims processing team(s). Directs workflow to ensure the efficient and accurate ... and fostering collaboration with internal and external stakeholders to optimize claim processing , minimize errors, and enhance overall operational effectiveness… more
    CVS Health (07/16/25)
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  • Pharmacy Claims Auditor - Remote

    Prime Therapeutics (Columbus, OH)
    …skill and understanding of the point of sale and on-line pharmacy claims processing environment + Excellent oral, written and interpersonal communication ... fuels our passion and drives every decision we make. **Job Posting Title** Pharmacy Claims Auditor - Remote **Job Description** The Pharmacy Claims Auditor is… more
    Prime Therapeutics (07/25/25)
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  • Clinical Documentation and Claims Integrity…

    Elevance Health (Mason, OH)
    …The **Clinical Document Improvement Director** is responsible for leading encounter processing , diagnostic documentation and claims integrity across CareBridge. ... / revenue cycle management (RCM) organizations, with specific understanding in end-to-end claims / encounter processing , as well as ensuring compliance with… more
    Elevance Health (07/18/25)
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  • Director, Appeals & Grievances (Medicare…

    Molina Healthcare (Dayton, OH)
    …experience in healthcare claims review and/or Provider appeals and grievance processing /resolution, including 2 years in a manager role. * Experience ... Medicare standards and requirements related to non-contracted provider dispute/appeals processing . * Establishes member and non-contracted provider grievance/dispute and… more
    Molina Healthcare (07/18/25)
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  • Pharmacy Benefit Manager Invoice Processor…

    CVS Health (Columbus, OH)
    …files. + Reconciles and balances claims data and invoices in the claims processing system. + Coordinates client billing and invoice payments. + Communicate ... + Imports and monitors PBM claim data and invoice...years of experience with health care data entry and/or claims processing . + 1-3 years of customer service… more
    CVS Health (07/25/25)
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  • Pharmacy Benefit Manager Data Analyst…

    CVS Health (Columbus, OH)
    …investigation of plan set-up and overapplied accumulators by running reports from the claim processing system and conducting thorough audits. + Identifies and ... and every day. **Position Summary** The **PBM Data Analyst** performs prescription claim and accumulator audits, verifies policy coverage, assesses claim … more
    CVS Health (07/18/25)
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  • Lead Analyst, Configuration Oversight - Payment…

    Molina Healthcare (OH)
    …teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, ... and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen. Experience in… more
    Molina Healthcare (07/24/25)
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  • Payment Integrity Program Manager - Health…

    Molina Healthcare (Cincinnati, OH)
    …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Create succinct ... **Job Description** **Job Summary** The Payment Integrity Program Manager - Health Plan is a subject matter...operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to… more
    Molina Healthcare (06/29/25)
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  • Project Manager - Third Party Client Audit

    CVS Health (Columbus, OH)
    …measuring and monitoring the quality and effectiveness of work processes in claim processing and/or customer service that impact customer satisfaction, medical ... cost management, and operational efficiency. Meritain Health's Project Manager for Third Party Client Audits will be responsible for the following: + Manage… more
    CVS Health (07/18/25)
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  • Senior Manager , Specialty Pharmacy…

    Otsuka America Pharmaceutical Inc. (Columbus, OH)
    …Specialty Pharmacy Operations We are seeking a detail-oriented and proactive Senior Manager of Pharmacy Operations to support the operational execution of our new ... operations, and addressing any operational issues that arise. The Senior Manager will also collaborate closely with Account Managers, Field Reimbursement Managers,… more
    Otsuka America Pharmaceutical Inc. (07/09/25)
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