- 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
- 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
- Walgreens (Canal Winchester, OH)
- …accordance with Company policies and procedures. Responsible for operating pharmacy systems to obtain patient and drug information and process prescriptions. Assists ... pharmacy technicians and Fulfillment Specialists in the operation of pharmacy systems . Models and delivers a positive customer experience. **Job Responsibilities:**… 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
- Evolent (Columbus, OH)
- …Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems ... interactions fostering expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. **Qualifications… more
- Molina Healthcare (Columbus, 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
- 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
- Cognizant (Columbus, OH)
- …equivalent education or work experience; bachelor's degree preferred. + Experience working with claims payment systems and Medicare data analytics. + Strong ... issue resolution. **Primary Responsibilities** : + Identifies and interprets data , submission requirements, and performance metrics per the regulatory and… 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 (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
- 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
- Highmark Health (Columbus, OH)
- …overall business targets or assigned volume of new applications or RFP's.Utilize various systems and tools to obtain necessary data and accurately complete and ... quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …- Interacts effectively with internal/external functional business units to gather data and develop documentation required for on-time submissions. - Works closely ... (Word, Excel, PowerPoint, Outlook) and familiarity with electronic document management systems (EDMS). **Competencies** See OPDC Competencies Chart (Level X) **P**… more
- CVS Health (Columbus, OH)
- …Salesforce. + Market and place stop loss policies, negotiating terms based upon claims data , strategy, relationships and cost avoidance/reduction efforts. + Work ... impacts for custom requests. + Manage and interpret operational data and apply to fee development and financial analysis....Meritain products and services along with strong business and systems knowledge. + Reviews work for accuracy and recommends… more
- Iron Mountain (Columbus, OH)
- …solutions in records and information management, digital transformation services, data centers, asset lifecycle management, and fine art storage, handling, ... artifacts, extract more from their inventory, and protect their data privacy in innovative and socially responsible ways. Are...costs. This position will report directly to the Global Sr . Commercial Director, and will work closely with members… more