- Molina Healthcare (Columbus, OH)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- The Hartford (Columbus, OH)
- Sr Data Scientist - GD07AE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working ... Step into the future with The Hartford as a Data Scientist / Sr Data ...Join a team that's pioneering AI-driven solutions in underwriting, claims processing, and customer service, transforming how we operate… more
- The Hartford (Columbus, OH)
- Sr Data Scientist - GD07AEData Scientist - GD08AE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages ... Step into the future with The Hartford as a Data Scientist / Sr Data ...Join a team that's pioneering AI-driven solutions in underwriting, claims processing, and customer service, transforming how we operate… more
- UIC Government Services and the Bowhead Family of Companies (Wright Patterson AFB, OH)
- **Overview** SR . ENTERPRISE ARCHITECT (EAS): Bowhead is seeking an experienced Sr . Enterprise Architect to join our team at Wright-Patterson AFB, OH for a ... (DoDAF), Unified Architecture Framework (UAF), Unified Modeling Language (UML), and Systems Modeling Language (SysML) experience are highly encouraged to apply. This… more
- Canon USA & Affiliates (Columbus, OH)
- **Mgr Medical Affairs - Clinical Development Sr - HIT - req1494** **OVERVIEW** Works independently and as part of a dynamic and fast-paced team of clinical and ... and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business,… more
- The Hartford (Columbus, OH)
- …The Customer Operations Data Science & Analytics team is seeking a Senior Analyst to support analytics across the Contact Center Operations (CCO) Portfolio for ... Sr Consultant Perf Analytics - GB07AE We're determined...as we help shape the future. The Customer Operations Data Science & Analytics team engineers end-to-end analytic and… more
- Sumitomo Pharma (Columbus, OH)
- …computer systems . + Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts. + Ensures detailed accuracy ... highly motivated, and experienced individual for the position of Sr . Manager, Medicaid Contract Administration. This position is responsible...of correct data input into company systems . + Maintains… more
- Evolent (Columbus, OH)
- …mission. Stay for the culture. **What You'll Be Doing:** Evolent Health is looking for a Sr . Product Owner within our Common Data portfolio to be a key member of ... a technical field or relevant related field + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical data… more
- Evolent (Columbus, OH)
- …data using industry-standard metrics. + Process and validate raw unadjudicated claims data . **Qualifications Required and Preferred:** + Bachelor's degree, ... Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems… more
- Molina Healthcare (Akron, OH)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Evolent (Columbus, OH)
- …skills + Microsoft Office experience (Excel, Visio) + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical ... You'll Be Doing:** Evolent Health is looking for a Senior Product Owner to be a key member of...key member of the Product team, focused on client data integrations. This individual will play a critical role… more
- ITW (Troy, OH)
- …Warewash and Waste Division of ITW's Food Equipment Group, is seeking a Senior Manager specializing in product quality and customer relations. This position will ... markets, as well as new markets, which requires a Senior Manager to lead projects to continuously improve product...concerns + Work with the Service Division to resolve claims and provide service parts to customers + Work… more
- Central Ohio Transit Authority (Columbus, OH)
- …subdivision under ORC 2744; + Reviews all event reports for accuracy; creates claims , and maintains documentation in applicable systems (Origami); + Conducts ... including research on the claimant, such as other past claims , industrial and doctor/hospital reports; decides whether to deny...a timely manner and, if applicable, prepare them for Senior Associate Legal Counsel to file a lawsuit. +… more
- Elevance Health (Mason, OH)
- …rules. **Preferred Skills, Capabilities, and Experience:** + Experience working with encounter data systems within a healthcare payer or RCM organization and ... **Clinical Documentation and Claims Integrity Director** **Location:** Alternate locations may be...to ensure high quality encounter submissions. + Liaises with senior CareBridge and Elevance Health leadership across Product, Analytics,… more
- Highmark Health (Columbus, OH)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... of applications he/she supports, how users use the application, and what other systems integrate with the application. Understands how work is being conducted, and… more
- Molina Healthcare (Cleveland, OH)
- …Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data , pharmacy data , lab data , and ... **JOB DESCRIPTION** **Job Summary** This Sr . Analyst, Healthcare Analytics role will be responsible...I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + Data… more
- Molina Healthcare (Columbus, OH)
- … systems to support executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...evaluate the impact of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …Operational Support will be responsible for managing and enhancing platform integrations across data systems , Salesforce Health Cloud and other CRM systems , ... and related CRM system integrations with internal and external systems , data platforms, and analytics solutions. +...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Elevance Health (Mason, OH)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** _Hybrid 1: This role requires associates to...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Elevance Health (Columbus, OH)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more